International Journal of Surgery Case Reports最新文献

Introduction: A hemolytic transfusion reaction is the destruction of red blood cells caused by immunological incompatibility between the donor and the recipient, not only incompatibility but also, rarely, compatible blood transfusion, which may cause a hemolytic transfusion reaction. A hemolytic transfusion reaction occurs when the transfusion causes symptoms as well as clinical or laboratory indicators of increased red cell death.

Patient presentation: We present the case of a 27-year-old Gravida II Para I mother who was blood group AB positive with anaemia, hypotension secondary to antepartum hemorrhage, and a mentally conscious mother who was transferred to our obstetric emergency operation theatre. As she experienced bleeding on arrival, we assessed the patient's history and performed anaesthesia-related physical examinations, such as cardiovascular examination, respiratory examination, central nerve system examination, and airway examination. We followed the patient postoperatively until discharge from the hospital, and 12.9 g/dl hemoglobin, 36.3 % haematocrit, 402 × 10³ platelet count, and 0.9 mg/dl creatinine were detected. After satisfactory postoperative vital signs and laboratory results were obtained, the patient was discharged from the hospital after 3 days.

Clinical discussion: Acute hemolytic transfusion is a medical emergency with an estimated frequency of one per 70,000 blood product transfusions and an estimated fatality rate of five per 10 million RBC unit transfusions. Importantly, the traditional triad of fever, flank pain, and red or dark urine is uncommon. However, these symptoms may not be immediately visible if the patient is under anaesthesia; in such circumstances, seeping from venipuncture and dark urine caused by DIC and hemoglobinuria, respectively, may be the only observations.

Conclusion: Blood transfusion is performed in 0.5-3 % of women with obstetric hemorrhage and accounts for 1 % of all transfused blood products in high-income countries. Anesthesiologists face a significant issue in identifying the necessity for transfusion in patients with obstetric hemorrhage. Hemolytic reactions after blood transfusion are common during emergency patient management. For this reason, the World Health Organization has developed guidelines for early detection and management.

Introduction: Lipomas are the most common benign mesenchymal tumors, making up 50 % of soft tissue tumors. However, while they frequently occur in areas like the head, neck, shoulders, and back, lipomas in the hands and wrists are rare, particularly in the fingers where they are exceptionally uncommon.

Case presentation: We present a case of 62-year-old female presented with a six-year history of a gradually enlarging, painful swelling on the palmar aspect at the base of her left index finger. Examination revealed a soft, fluctuating, 3 cm × 2 cm swelling. USG and MRI suspected it to be a lipoma. The lesion was excised, and histopathology confirmed a benign lipoma.

Discussion: Lipomas, derived from mesenchymal preadipocytes, often have genetic and metabolic links, including in individuals with obesity, hyperlipidemia, and diabetes. While typically asymptomatic, lipomas in the hands and fingers can cause pain and impairment, necessitating surgical resection. Accurate diagnosis may require imaging, and treatment yields favourable outcomes with low recurrence rates.

Conclusion: Despite their rarity, lipomas in the hands and fingers should be considered when evaluating non-discharging swellings. Surgical resection is the primary treatment.

Introduction and importance: Lymphangiomas are rare benign lymphatic malformations, typically affecting the head, neck, or axillary regions, with abdominal cystic lymphatic malformations (CLM) being particularly uncommon in adults. Abdominal CLM account for less than 5 % of all lymphangiomas and 7 % of all abdominal cystic lesions in adults with a prevalence of approximately 1 in 250,000. These lesions are commonly found by accident during imaging investigations and are asymptomatic. Being free of any attachment, floating in the peritoneal cavity make it unique in its presentation.

Case presentation: We report a case of 25-year-old female who complaining of right upper abdominal pain. Initial laboratory and imaging studies by abdominal computed tomography (CT) scan showed multiple complex cysts with undetermined origin. Exploration laparoscopy was performed, revealing over 50 variable-sized cysts, some of them were floating freely within the abdominal cavity. Complete resection of all cysts was performed. Postoperative recovery was uneventful, and histopathological examination confirmed the diagnosis of cystic lymphangiomas.

Clinical discussion: This case demonstrates the unusual presentation of multiple, floating, and variably sized intra-abdominal cystic lymphangiomas, a rare finding that presents significant diagnostic and management challenges. The absence of attachment to common intra-abdominal structures, such as the mesentery or omentum, further complicates the clinical picture.

Conclusion: Abdominal CLM must be considered as possible diagnosis especially if the cysts are multiple and complex. Freely floating abdominal CLM may cause the symptoms of a moving lump described by the patient, which must be taken in consideration.

Introduction: Anterior fracture dislocation of the humerus with an anatomical neck fracture is an uncommon injury. These injuries pose a significant risk of devastating complications, such as avascular necrosis of the humeral head, due to the poor vascularization of the area, and stiffness resulting from prolonged immobilization.

Clinical presentation: We report a case of a 20-year-old female who was involved in a motor vehicle crash and sustained an anterior fracture dislocation of the humerus with an anatomical neck fracture. The injury was successfully managed with open reduction and internal fixation using a plate and screws. Given the rarity of this type of injury, this case provides valuable insights into its management and prognosis.

Discussion: Proximal humeral fractures are common injuries, although fractures at the level of the anatomical neck are less common in orthopedic traumatology. The management of these injuries is guided by factors such as fracture morphology, displacement, potential disruption to blood supply, bone quality, patient's age, and functional demands. Various surgical management strategies have been proposed, emphasizing early intervention to minimize the risk of complications.

Conclusion: This case aims to highlight the importance of the value of early operative intervention, good anatomic reduction with stable fixation, and the importance of early mobilization of the shoulder to achieve favorable outcomes and minimize complications such as stiffness in patients with this type of injury.