Journal of Surgical Case Reports最新文献

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.

Extracranial metastases from meningioma are exceedingly rare, representing <1% of all cases, with appendicular skeletal involvement being exceptional. We report a 51-year-old woman who developed a destructive iliac bone lesion ten years after complete resection of a WHO Grade II (atypical) parietal meningioma. Computed-tomography-guided biopsy confirmed metastatic meningioma morphologically identical to the original tumor. A systematic review (1959-2024) identified 26 reported cases of appendicular skeletal metastases, most frequently involving the femur and iliac bone, with a mean latency of 8.9 years. These findings emphasize the indolent yet unpredictable metastatic potential of atypical meningiomas and highlight the importance of lifelong surveillance, as metastasis should be considered even after prolonged disease-free intervals.

Post-traumatic ankle osteoarthritis (OA) is a frequent consequence of recurrent injuries among athletes. When conservative management fails, surgical options such as total ankle arthroplasty or arthrodesis are considered. Although ankle arthrodesis (AA) is effective for pain relief, it is generally regarded as incompatible with high-impact sports due to loss of motion and altered biomechanics. We report a 41-year-old professional female wrestler with end-stage post-traumatic AO who underwent arthroscopic AA. She returned to professional competition 6 months postoperatively and continued to perform at an elite level for over 6 years without ankle-related complications. The Japanese Orthopaedic Association score improved from 56.0 preoperatively to 84.7 at the final follow-up. This case demonstrates that with meticulous surgical technique, structured rehabilitation, and sport-specific adaptation, AA can enable selected athletes to achieve sustained high-level function. Careful patient selection and individualized management remain essential.

Substernal goiters (SGs) with significant mediastinal extension can present complex surgical dilemmas. While most SGs can be resected through a low cervical collar incision, a full median sternotomy may be required in select cases. Morbidly obese patients are susceptible to adverse outcomes following full sternotomy, such as wound infection and sternal dehiscence. Partial upper sternotomy is a safe, effective alternative that offers sufficient access to the mediastinum while minimizing surgical morbidity, making it a valuable approach in this high-risk population. We present the case of a 33-year-old female with a BMI of 47 kg/m² who was found to have a large symptomatic SG with significant mediastinal extension. Due to the depth of extension, a combined cervical and trans-sternal approach was planned. A partial upper sternotomy was performed to avoid the morbidity of full sternotomy. The patient tolerated the procedure well without complications and was discharged home on postoperative day two.

Bowel intussusception is a rare cause of obstruction in adults. Unlike the paediatric population, the etiology of adult intussusception is typically an underlying intestinal tumour, which can be benign or malignant, resulting in partial or complete mechanical ileus and corresponding symptoms. Diagnosing it through imaging techniques can be challenging and is sometimes only confirmed after an exploratory laparotomy. Surgical treatment in adults is often necessary because it aims not only to resolve the intussusception but also to address the underlying cause. We present three cases of surgically treated adult intussusception and discuss key points in managing this condition, based on a review of the literature.

Although the lithotomy or Lloyd-Davies position is standard for laparoscopic or robotic abdominoperineal resection for lower rectal cancer, visualization and instrument maneuverability can be limited in cases involving bulky tumours with invasion of adjacent organs. We report a case of a bulky rectal cancer with uterine invasion that was successfully resected via the perineal approach, with excellent visualization achieved using the right lateral decubitus position.