Journal of Surgical Case Reports最新文献

Esophageal lipomatous tumors are extremely rare, and due to their nonspecific clinical manifestations, distinguishing them is nearly impossible without the aid of histopathology, immunohistochemistry, and molecular analysis. Complete resection with clear margins is the treatment of choice to avert metastasis, improve prognosis, and prevent complex complications due to the polyp growth and location. We present the case of a 70-year-old male who presented in 2023 with dysphagia due to an esophageal polyp; surgery was recommended. However, he did not accept any treatment due to fear. One year later, and since his symptoms worsened, he finally decided to undergo endoscopic treatment at another medical institution. However, during that procedure, he suffered severe asphyxia, which caused a cardiopulmonary arrest. Once he partially recovered and because he continued with dysphagia, surgery was completed, and the polyp was removed. The final diagnosis was esophageal liposarcoma.

Papillary fibroelastoma of aortic valve is a rare benign tumor that can present with symptoms of obstruction or embolization and can be asymptomatic. The main stay of diagnosis is echocardiography. The size of the tumor affects the sensitivity of transthoracic echocardiography which can miss small size tumors. The treatment is surgical resection. Here, we report a case of papillary fibroelastoma of aortic valve that was detected intraoperatively by transesophageal echocardiography and was missed by transthoracic echocardiography in a patient undergoing coronary artery surgery. The tumor was resected successfully with preservation of aortic valve with no complication. This case highlights importance of intraoperative transesophageal echocardiography in making the diagnosis.

Hernias are a common cause of small bowel obstruction. Many different classifications of hernias exist, all differing by location throughout the abdomen and hernia contents. We present a case report that describes a unique hernia-a peritoneal invagination hernia-which may lead to small bowel obstruction. The peritoneal invagination hernia is a defect in the peritoneum, in this case located on the right anterolateral abdominal wall, allowing small bowel to enter and become incarcerated. In our patient, the peritoneal defect was circular with smooth, rolled borders. The defect contained intact peritoneum overlying intact transversalis fascia. The patient had no prior abdominal surgeries. This hernia differs by location and etiology from preperitoneal interparietal hernias, which are found in the inguinal and femoral regions. This case describes a newly characterized abdominal hernia which is hypothesized to be due to a prior intra-abdominal inflammatory process.

Coronary artery disease occurs when coronary vessels are unable to supply adequate oxygen to the myocardium, while an abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta. Both conditions have similar risk factors such as smoking and hypertension. If these disease processes become severe and are left untreated, life-threatening consequences may occur. We present a 71-year-old male with prior myocardial infarction and an infrarenal AAA that underwent a rare combined procedure of coronary artery bypass grafting (CABG) and open AAA repair surgery. The CABG involved grafting the left internal mammary artery and saphenous vein to coronary arteries while the AAA repair used an 18-mm bifurcated aortic graft. Combined CABG and open AAA repair is complex and rare, but aims to reduce mortality and prevent aneurysm rupture in patients with severe comorbid conditions. The patient's positive postoperative outcome highlights the procedure's efficacy in select cases.

Chylothorax is a rare condition in which chylous fluid accumulates in the pleural cavity, most often due to iatrogenic injury of the thoracic duct. This paper reports a case of a woman in her 50s presenting with chyle leakage after a video-assisted mediastinoscopic lymphadenectomy (VAMLA) for staging of a nodule suspected of non-small cell lung carcinoma. After the VAMLA, a Uniportal Video Assisted Thoracoscopic Surgery lobectomy was scheduled during which the chylothorax was observed. The chyle was evacuated and the planned resection was conducted. The chest drain could be removed after 6 days while the patient followed a medium-chain triglyceride diet for 4 weeks. The purpose of this case report is to raise awareness for this very rare complication after VAMLA and discuss treatment options.

Myxomas are the most common type of benign cardiac tumors, and the right atrium is the second most common location among them, with an incidence ranging from 8.6% to 20% of all cardiac myxomas. Herein, we described a rare case of right atrial myxoma originating from the inferior vena cava orifice. In this case, main pulmonary artery cannulation and moderate hypothermic circulatory arrest were helpful to obtain a clear and simple view of the operative field without blood, which led to complete resection of the tumor with safety and better outcomes with no future recurrence.

Perineal verrucous carcinoma is a rare variant of squamous cell carcinoma that is mainly treated with surgical excision. In this case report, we present a 58-year-old man with human immunodeficiency virus who presented with an extraordinarily large perineal mass that was ultimately found to be verrucous carcinoma in association with giant condyloma acuminata. He was treated with a wide local excision followed by staged abdominoperineal resection and fasciocutaneous flap reconstruction. In the post-operative course, the patient developed relatively short interval recurrence which was successfully managed with salvage radiotherapy. He is now post-radiation without evidence of recurrence.

Postsurgical pyoderma gangrenosum (PSPG) is a rare, ulcerative skin condition that presents a diagnostic challenge due to its similar presentation to infectious etiologies in the postsurgical period-often leading to gratuitous and unnecessary surgery and antibiotic use. We report a 37-year-old female with breast cancer who received neoadjuvant chemotherapy and immunotherapy and underwent bilateral skin-sparing mastectomies who developed delayed bilateral mastectomy skin flap necrosis secondary to PSPG. This case had rare factors associated with the development of PSPG such as preoperative systemic therapy and a familial component. This case underscores the importance of early recognition of this rare disease and appropriate management of PSPG to prevent unnecessary interventions and ensure an optimal outcome.

Bronchogenic cysts, a rare congenital pulmonary disorder, typically affect young adults and are often managed conservatively. However, large cysts with recurrent infections require surgical intervention. This case study highlights the successful management of a large bronchogenic cyst. A 53-year-old female presented with a decade-long history of recurrent respiratory infections manifesting as cough, yellow purulent sputum, and shortness of breath. Chest computed tomography revealed a large bronchogenic cyst in the right middle lobe, causing cardiac compression. Despite conservative management, the recurrent symptoms persisted. After multidisciplinary consultation, a thoracoscopic right middle lobectomy was planned. Severe pleural adhesions and bleeding complicated the procedure; therefore, thoracotomy was performed. Postoperatively, the patient developed transient fever and elevated white blood cell count, both of which resolved with appropriate antibiotic therapy. The patient was discharged in stable condition, with no recurrence of symptoms at follow-up. Large, symptomatic bronchogenic cysts that cause recurrent infections require surgical resection.

Neuroendocrine tumors (NETs) are usually found in the gastrointestinal tract and pancreas; however, they are rare in the middle ear. The presentation of vague symptoms, such as tinnitus and conductive hearing loss, complicates the diagnosis. We present a 46-year-old male with a history of right ear discharge and a previous canal wall-down mastoidectomy, suspected to have cholesteatoma recurrence. Imaging and surgery demonstrated a well-differentiated G1 NET in the middle ear. Postoperative metastatic workup revealed few pulmonary nodules needing ongoing observation. Middle-ear NETs are difficult to diagnose due to their rarity. This case underscores the importance of histological and immunohistochemical evaluation and the need for systemic assessment to rule out metastasis due to pulmonary nodules. We contribute to the limited literature highlighting the need to include NETs in the differential of middle ear masses and the usefulness of interdisciplinary teamwork.