Journal of Surgical Case Reports最新文献

Leriche syndrome is an occlusive disease involving the abdominal aorta and iliac arteries that is frequently associated with ischemic heart disease (IHD). The internal thoracic arteries in patients with Leriche syndrome often serve as important collateral pathways to the lower extremities. Therefore, graft selection for coronary artery bypass grafting (CABG) requires special consideration. We performed on-pump total venous CABG in a patient with acute heart failure secondary to IHD complicated by Leriche syndrome who required emergent coronary revascularization. This strategy was chosen to preserve lower limb perfusion. When coronary revascularization is a priority for patients with IHD complicated by Leriche syndrome, on-pump total venous CABG is a reasonable option because of the need to preserve lower limb perfusion and difficulty of using mechanical circulatory support devices for occlusive disease.

Laparoscopic transabdominal preperitoneal (TAPP) repair is the gold standard for treatment of inguinal hernia. Its complications are well known; however, its rare complications, such as mesh erosion and migration are commonly overlooked. There is established evidence about mesh complications; however, we have not found a similar case to what we encountered. We present a case of an elderly male who presented with a closed-loop bowel obstruction following a TAPP repair. Intraoperatively, the appendix tip was adherent to the eroded mesh through a defect in the peritoneal flap. The appendix formed a constricting wrap around the terminal ileum with a resultant ischemia of the bowel in the presence of a competent ileocecal valve. Reasons accounting to mesh erosion can be divided into primary and secondary causes. Complications from mesh erosion vary from fistulation up to bowel ischemia. Failure to recognize these complications can lead to considerable morbidity.

A residual lung parenchyma abscess following pulmonary resection for lung cancer is a rare and potentially serious condition. We present a case of successful nonoperative management of a lung abscess that developed after a right upper lobectomy for adenocarcinoma in a 76-year-old man who experienced systemic symptoms 6 weeks after his initial surgery. Imaging revealed an abscess in the previous surgical cavity. We discuss management strategies and challenges associated with this uncommon condition.

The ex-utero intrapartum treatment (EXIT) procedure preserves fetal oxygenation via the umbilical cord in urgent respiratory distress. We report a rare case of congenital extralobar pulmonary sequestration with pedicle torsion. A 22-year-old primigravida at 29 + 4 weeks presented with a fetal supradiaphragmatic mass, hydrothorax, and cardiac displacement; fetal magnetic resonance imaging (MRI) confirmed pulmonary sequestration. Rapid fetal deterioration led to the termination of the pregnancy and the application of ex-utero intrapartum treatment procedure during Cesarean section. Before cord clamping, intubation along with thoracocentesis enabled neonatal breathing. The 2140 g newborn required intensive care for respiratory distress, heart failure, and pulmonary hypertension and was discharged stable after 3 weeks. Elective thoracoscopy at the age of 6 months removed the sequestration, confirming pedicle torsion; recovery was uneventful. This case highlights the importance of early diagnosis, multidisciplinary collaboration, and timely use of ex-utero intrapartum treatment to manage life-threatening fetal lung anomalies.

Collision tumors of the thyroid gland are defined by the coexistence of two or more histologically and morphologically distinct neoplasms, separated by normal thyroid tissue. This phenomenon is rare, with the most frequently reported combination being the coexistence of medullary carcinoma and papillary carcinoma. This case reports a 73-year-old female patient with an asymptomatic thyroid nodule. Ultrasonographic examination revealed a solid, isoechoic, well-defined nodule with a halo and peripheral vascularization, measuring 4.3 × 2.5 cm in the left lobe. Fine-needle aspiration cytology classified the nodule as Bethesda IV (follicular tumor). Following total thyroidectomy, histopathological analysis identified papillary carcinoma in the isthmus and minimally invasive follicular carcinoma in the left lobe.

We present the case of a 34-year-old male with right flank pain. Computed tomography revealed at least six cortical, expansible, fat-density lesions in the right kidney and two similar lesions in the left kidney, consistent with angiomyolipomas. Surgical management consisted of radical right nephrectomy with immediate renal autotransplantation. Ex vivo tumour excision was performed under ultrasound guidance and hydrodissection, followed by cortical reconstruction and reimplantation into the ipsilateral iliac fossa. Vascular anastomoses were fashioned end-to-side to the external iliac vessels, and ureteral reimplantation was achieved using the Taguchi technique with double-J stent placement. The postoperative course was uneventful, with preserved renal function. This case highlights the value of multidisciplinary assessment, individualized planning, and meticulous surgical technique to avoid unnecessary radical nephrectomy, particularly in patients with bilateral renal tumors.

Atraumatic or spontaneous splenic rupture is a rare but life-threatening emergency. Common causes include hematologic malignancies and infections, but tuberculous involvement of the spleen is exceedingly uncommon. To our knowledge, this represents the third reported case of spontaneous rupture of a tuberculous spleen. We report a 50-year-old human immunodeficiency virus (HIV) -positive woman who presented with cough, fever, and abdominal distension, with abdominal examination suggesting peritoneal irritation and laboratory tests showing severe anemia. Emergency laparotomy revealed a ruptured spleen with 500 ml of hemolyzed blood, and splenectomy was performed. Histopathology confirmed splenic tuberculosis. The postoperative course was uneventful. Splenic tuberculosis typically occurs in disseminated disease among immunocompromised individuals. Fever of unknown origin is the commonest presentation; spontaneous rupture is exceptionally rare and difficult to diagnose. Although antitubercular therapy is the mainstay of treatment, hemodynamically unstable patients require surgery. Spontaneous splenic rupture should be considered in immunocompromised patients with an acute abdomen, as early recognition is lifesaving.

Acute pelvic pain during pregnancy often presents a diagnostic challenge. We report a case of adnexal torsion occurring in the third trimester of pregnancy in order to highlight this diagnosis, for which only early management can prevent irreversible ischemic damage that may compromise future fertility. The patient was a nulliparous woman at 30 weeks of amenorrhea who initially presented with symptoms suggestive of appendicitis. Through a McBurney incision, surgical exploration revealed a necrotic right ovary associated with reactive appendicitis. An oophorectomy and appendectomy were performed. The postoperative course was uneventful.

Colonic stricture leading to large bowel obstruction is an uncommon presentation to the emergency department. Strictures are commonly established secondary to diverticular disease, inflammatory bowel disease, malignancy or ischaemic/infective colitis. The formation of a colonic stricture secondary to the chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) is an unusual finding. We present a case of a 48-year-old lady who presented with a large bowel obstruction secondary to NSAID-induced right colonic stricture in a patient who was initially thought to have an index presentation of colonic Crohn's disease.