Journal of Surgical Case Reports最新文献

Laparoscopic cholecystectomy is the preferred method for treating acute cholecystitis. Although the incidence of postoperative infections in laparoscopic cholecystectomy is low, serious postoperative surgical site infections are still reported. Hepatic abscesses, particularly fungal, can occur post-cholecystectomy leading to significant mortality and morbidity. We report a case of a 58-year-old female who underwent laparoscopic cholecystectomy and subsequently developed fever, jaundice, and right upper quadrant pain. Laboratory results showed deranged liver function tests with raised inflammatory markers. Radiographic investigations, including CT and MRI, revealed an irregular hilar lesion with periportal changes suggestive of an abscess with portal vein thrombosis. Histopathological examination of the biopsy obtained from the hilar lesion showed a fungal hepatic infection, and particularly conidiobolomycosis. To our best knowledge, this is the first case that reports this fungal infection as a complication of laparoscopic cholecystectomy. The patient was managed with a combination of intravenous antibiotics and antifungals, which yielded mild improvement. Unfortunately, the patient decided to leave the hospital against medical advice, limiting the information on the disease course.

The diffuse large B-cell lymphoma (DLBCL) mimicking an epidural hematoma in the cervical spine is an extremely unique case. We present a case of a 42-year-old man, who presented to the emergency department with symptoms of tetraparesis after a session of spinal manipulation therapy. magnetic resonance imaging visualized a lesion located at C3-C7 causing spinal cord compression with surrounding soft tissue edema suggesting epidural hematoma. The patient was admitted to the Neurosurgery Department and emergent laminectomy was performed. Intraoperatively, an infiltrating tumor was found, which was partially resected and sent for post-op histopathological examination, determining it to be a DLBCL. Our work aims to increase awareness of such cases, which may make it easier to make the proper diagnosis.

Endovascular repair of aortic injuries secondary to blunt trauma has been widely described. However, literature on endovascular management in penetrating aortic injuries is scarce. The patient in this case report, a victim of penetrating thoracic aortic trauma, presented 5 days after injury with Brown-Sequard syndrome and a contained aortic injury (pseudoaneurysm) and was haemodynamically stable. Therefore, thoracic endovascular aortic repair was an option in this case. Endovascular repair carries a lower peri-operative morbidity and mortality rate than open repair. However, because most cases of penetrating thoracic vascular injury have haemodynamic instability, open surgery is considered the standard of care. This case demonstrates successful management of an aortic injury with a minimally invasive procedure.

Endoscopic management of transmural oesophageal defects following esophagectomy or spontaneous perforations, such as Boerhaave's syndrome, is often complicated by stent migration and luminal occlusion [1]. The Vacuum-Assisted Closure (VAC) stent, which integrates a covered stent with endoscopic vacuum therapy, aims to address these issues by providing functional drainage and promoting wound healing [2]. This case series presents our initial experience with VACStent therapy in four patients treated between February 2023 and April 2024. Two patients had staple line defects post-esophagectomy, and two had Boerhaave's syndrome. Treatment involved stent placement under general anaesthesia, followed by evaluations and scheduled stent exchanges every 6 days. All patients achieved successful defect closure, with no procedural complications noted. Three patients required one stent application, while one needed two applications. VACStent therapy appears to be a safe and effective treatment for transmural oesophageal defects, potentially establishing a new standard of care.

The perianal abscess is a common emergency surgical presentation. While in most cases simple drainage suffices, occasionally the abscess can track deeply presenting a management challenge. We describe the case of a complex circumferential horseshoe ischioanal abscess with extension below the levator ani through the greater sciatic notch and into the left gluteal region, with the collection involving the intergluteal space and gluteus maximus. The complex nature of the abscess warranted a novel joint approach by Colorectal surgery and Orthopaedic surgery teams. This case highlights the importance of maintaining a high degree of suspicion for, early recognition and imaging of deeper anorectal abscess extension.

Primary total knee arthroplasty (TKA) is a successful and cost-effective procedure for which demand is increasing annually. Outcomes are generally good with satisfaction rates of 70%, so the procedure is commonly used in osteoarthritis management to improve mobility and alleviate pain. Above knee amputation (AKA) is a devastating complication of TKA. AKA is associated with high mortality, phantom pain, and non-ambulatory disability. In the US, the incidence of AKAs due to periprosthetic joint infection (PJI) is rising drastically, with the proportion of AKAs performed due to PJI having almost quadrupled from 1998 to 2013. We present the case of a patient who developed severe uncontrolled infection following routine TKA, resulting in an above-knee amputation and ultimately death. Due to the extremity of the outcome and the rising incidence of the complication involved, this is an important case to discuss.

Colon lipomas are rare benign, nonepithelial tumors that are often asymptomatic. However, when symptoms do occur, they vary depending on the size and location of the lipoma and are generally nonspecific. Diagnosis is confirmed through histopathological analysis. Lipomas smaller than 2.5 cm can typically be observed without intervention, but larger or symptomatic lipomas require resection, which can be performed endoscopically or surgically. This case presents a rare phenomenon of synchronous left colonic lipoma leading to intestinal obstruction. Despite their benign nature, colonic lipomas can sometimes mimic malignant lesions, making histopathological analysis crucial for confirming the diagnosis.

Duplication of the vas deferens is a rare congenital anomaly, with an incidence of ~0.05% in the general population. It is typically discovered incidentally during surgeries involving the spermatic cord, such as inguinal hernia repair. This case report presents a 33-year-old male who underwent left inguinal hernioplasty, during which duplication of the vas deferens was incidentally identified. The patient had presented with left-sided inguinal swelling, painful testis, and a small left testis. Preoperative ultrasound suggested an inguinal hernia, but the vas deferens anomaly was only detected intraoperatively. The patient successfully underwent hernioplasty without postoperative complications. This case emphasizes the importance of recognizing rare anatomical variations like vas deferens duplication to prevent surgical complications.

While intussusception is a well described complication of Roux-en-Y gastric bypass (RYGB), cases of recurrent intussusception after lead point resection and reconstruction are described much less frequently. We present a case of a 28-year-old female with triple recurrent intussusception all of which were treated with surgical resection and reconstruction of her RYGB anastomoses. There is currently limited evidence to direct management in the setting of recurrent intussusception. This case highlights the importance of considering intussusception in the RYGB patient with abdominal pain as well as demonstrates a need for further investigation into pathomechanisms which may lead to recurrence.

Duplication of the vermiform appendix is a rare anomaly observed in patients undergoing appendectomy. A 27-month-old male toddler presented with a 9-day history of abdominal pain, vomiting, and diarrhea, progressing to an acute abdomen with signs of severe peritonitis. Intraoperative findings revealed a periappendicular infiltrate from a perforated vermiform appendix of the tenia coli type. A second, inflamed appendix was incidentally discovered in its typical location during the procedure. Vermiform appendix duplication presents a clinical challenge due to its rarity and potential for complications. According to the Cave-Wallbridge classification, this case represents Type B2, or the tenia coli variant, characterized by a perforated appendix originating at the tenia coli convergence and a smaller, secondary appendix in a retrocecal position. This case emphasizes the importance of thorough distal and proximal exploration during initial appendectomy when this anomaly is suspected, particularly in cases of Type B2.