Journal of Surgical Case Reports最新文献

Gastric volvulus is a rare and potentially life-threatening condition that usually presents acutely and requires immediate intervention via either endoscopic or surgical detorsion. Most often, it presents secondary to a hiatal hernia, with herniation and torsion of the stomach through the hiatus. Only a small subset of patients present with gastric volvulus after Nissen fundoplication for hiatal hernia repair. We report the case of an elderly patient with a previous hiatal hernia repair with Nissen fundoplication who presented with an intra-abdominal gastric volvulus that developed over the course of several months. The combination of her surgical history and volvulus etiology made her disease rare. She was treated with laparoscopic surgery and gastropexy with gastrostomy tube placement, which led to the resolution of the upper gastrointestinal symptoms.

Mucosal cysts are rare late complications of rhinoplasty, appearing anywhere from weeks to years post-surgery. The cyst's location can cause both cosmetic and functional issues. Definitive treatment requires complete surgical excision of the cyst and its capsule to prevent recurrence. A 32-year-old man presented with a 2 × 2-cm painless, soft nasal mass 3 years after open rhinoplasty. The mass had gradually enlarged over 6 months, leading to breathing difficulties. Physical examination revealed a pollybeak deformity. Imaging confirmed a well-defined cystic lesion. The cyst was excised through an open rhinoplasty approach, followed by reconstruction using a costal cartilage graft. The postoperative period was uneventful, with no recurrence or issues at 12 months follow-up. We highlight the importance of meticulous surgical techniques in rhinoplasty to reduce mucosal cyst formation. For cysts >1 cm, open rhinoplasty is preferred due to better reconstruction and lower recurrence rates.

Tip appendicitis is a rare and fatal complication after appendectomy. Diagnosing this condition requires a high level of suspicion due to its ambiguous and nonspecific symptoms. Radiological investigations such as ultrasound and computed tomography scans can aid in diagnosis. Early identification and treatment are of paramount importance for good patient outcomes. In most cases, Tip excision is the preferred treatment. However, antibiotics can also be a useful alternative. Conservative antibiotic treatment can be successful in certain situations, particularly when no fecaliths or perforation exists. Close monitoring is necessary to avoid the return of chronic appendicitis. We here introduce a case of a 47-year-old female patient who underwent an open appendectomy a year ago and is currently complaining of right lower quadrant abdominal pain. The patient was diagnosed with tip appendicitis. She was started on conservative antibiotic therapy and discharged home with good general conditions.

Endovascular aneurysm repair (EVAR) is commonly utilized for iliac artery aneurysms (IAA), yet some cases necessitate additional intervention due to aneurysm re-expansion. We report two cases: a 68-year-old male with a left internal IAA (IIAA) and an 80-year-old female with both a left common iliac artery aneurysm (CIAA) and IIAA, who underwent aneurysmorrhaphy following initial EVAR. Both procedures were successful, significantly reducing aneurysm size without immediate complications. The use of laparoscopy in aneurysmorrhaphy enhances oversight of inflow vessels and facilitates suturing in deep pelvic areas. Our cases indicate that incorporating laparoscopy can substantially improve surgical outcomes.

Chronic anal fistula represents a prevalent form of perianal disease that frequently originates from perianal infection. Specifically, perianal abscesses that are inadequately or improperly treated are susceptible to the development of chronic anal fistulas. In HIV-infected individuals, an impaired immune system significantly diminishes the body's capacity to combat infections and inflammation, thereby complicating the healing process of anal fistulas. Moreover, the impact of HIV on tissue repair results in a markedly prolonged healing process for wounds and tissue damage in these patients, exacerbating the difficulty in anal fistula resolution. Chronic anal fistulas that remain untreated for extended periods not only severely impair the patient's quality of life but also pose an increased risk of malignant transformation.

Despite significant advancements in early breast cancer detection, mastectomy remains a crucial treatment option for some patients. Immediate breast reconstruction post-mastectomy has emerged as an ideal procedure to minimize physical and psychosocial patient impacts, striving for improved cosmetic results. The "enhanced "Goldilocks mastectomy technique, characterized by nipple preservation or grafting and utilizing the fifth perforator anatomy, offers a sound approach to reconstruction in comorbid and large-breasted patients. This paper discusses the advantages, disadvantages, and real-world application of Goldilocks mastectomy in enhancing breast reconstruction outcomes and meeting patients' diverse needs.

Situs inversus totalis is a rare congenital anomaly, where the positions of major internal organs are reversed from their normal arrangement. This anatomical abnormality significantly increases the complexity of surgeries, especially in laparoscopic reoperations of the bile duct for patients with a history of abdominal surgery. Traditional anatomical landmarks and surgical steps need to be adjusted according to the patient's unique anatomy. This not only makes intraoperative identification of structures more challenging but also introduces greater uncertainty during the procedure. This case report summarizes the successful laparoscopic reoperation of the bile duct in a patient with situs inversus totalis, providing important reference and guidance for future similar procedures.

Pancreatoblastoma, a rare pancreatic tumor, exhibits diverse differentiation pathways, including acinar, ductal, and neuroendocrine lineages, often with distinct squamoid nests [3]. We present a notable case of pancreatoblastoma coexisting with large cell neuroendocrine carcinoma in a 10-year-old boy, presenting with abdominal discomfort, weight loss, and lesions in the pancreas, spleen, and liver visible on imaging. A liver biopsy revealed a poorly differentiated carcinoma with neuroendocrine features, while a splenic biopsy showed acinar cell differentiation, raising possible diagnoses of pancreatoblastoma or acinar cell carcinoma. Subsequent surgical resection after chemotherapy revealed diverse components within the pancreatoblastoma, including well-differentiated acinar and neuroendocrine cells, squamoid nests, and a high-grade neuroendocrine carcinoma. Genetic analysis detected pathogenic variants in TP53 and SMAD4, rarely found in pancreatoblastomas. This juxtaposition of large cell neuroendocrine carcinoma and pancreatoblastoma suggests a potential evolution from well-differentiated neuroendocrine tumors to poorly-differentiated carcinomas within pancreatoblastomas.

Primary intraosseous meningiomas are rare extradural tumors. They are typically slow-growing, painless, and asymptomatic until they cause a mass effect. We report a case of a calvarial primary intraosseous meningioma, which became symptomatic despite a very small size. A 67-year-old female with a history of precancerous breast tissue presented with right-sided stroke-like symptoms. Computed tomography showed right parietal convexity irregularity without hemorrhage or infarct. MRI indicated a right parietal calvarial signal abnormality and dural thickening, suggesting metastases or primary osseous neoplasm. A PET scan revealed heterogeneous uptake in the right parietal skull with no other abnormalities. Histology confirmed the diagnosis of primary intraosseous meningioma. Histopathological examination is crucial to avoid misdiagnosis and treatment planning, which may involve wide-margin skull resection, radiation, or both.