International Journal of Surgery Case Reports最新文献

Introduction: There are few reports on the treatment of pelvic posterior ring injury with Sacral 1 - Sacral 3(S1-S3)sacroiliac screw fixation. This article reports a case of pelvic posterior ring injury with S1 sacral dysmorphism treated with S1-S3 sacroiliac screw fixation and reviews the relevant research progress.

Presentation of the case: A 72-year-old man riding e-bike was struck by a car at a high speed and diagnosed with pelvic fracture. The patient successfully underwent treatment of 3 sacroiliac screws (S1-S3) fixation. Postoperative X-rays and CT scans confirmed that all screws were in good position and located in the bone corridors. Follow up pelvic Majeed score of 96 at 11th month after surgery.

Discussion: Preoperative CT scans of this patient showed that S1 segment was a dysmorphic sacrum with narrow corridor while S2 and S3 segments were wide corridors. S1-S3 sacroiliac screw fixation can be attempted.

Conclusion: For patients with posterior pelvic ring injury with S1 sacral dysmorphism, S1-S3 sacroiliac screw fixation may be a better choice.

Introduction and importance: Uterine arteriovenous malformations (UAVMs) are rare vascular anomalies caused by abnormal connections between uterine arteries and veins. They can lead to severe bleeding, requiring prompt and accurate diagnosis. Historically treated with hysterectomy, transcatheter vascular embolization has emerged as a fertility-sparing alternative.

Case presentation: A 25-year-old woman with a history of partial molar pregnancy presented with acute pelvic pain and abnormal uterine bleeding. Initial findings suggested an intrauterine pregnancy of uncertain viability. Recurrent bleeding, elevated β-hCG levels, and abnormal Doppler findings raised suspicion of gestational trophoblastic disease. Endometrial aspiration was performed, but bleeding recurred. Further imaging revealed a uterine arteriovenous malformation, confirmed by angiography. The malformation was successfully treated with selective arterial embolization. Histopathology later confirmed a first-trimester miscarriage without evidence of gestational trophoblastic disease.

Clinical discussion: UAVMs can mimic gestational trophoblastic disease due to overlapping clinical signs such as abnormal uterine bleeding and high vascularity Doppler patterns. Diagnosis requires a multidisciplinary approach and imaging expertise. In our case, transvaginal Doppler identified the pathognomonic high-velocity flow pattern, while angiography confirmed the UAVM and enabled immediate treatment. Selective arterial embolization was effective, preserving fertility and aligning with modern management practices.

Conclusion: This case emphasizes the importance of a thorough diagnostic approach in abnormal uterine bleeding. UAVMs should be considered in patients with risk factors. Selective arterial embolization is an effective fertility-sparing treatment, highlighting the value of multidisciplinary care in managing complex gynecological cases.

Introduction: Choledochal cysts are rare congenital anomalies of the bile ducts, with adult presentations being uncommon. This case is notable for its atypical presentation in a young adult, mimicking a hydatid cyst in a region where echinococcosis is endemic.

Case presentation: A 22-year-old female presented with a 3-month history of progressive jaundice, accompanied by 5 months of epigastric and right upper quadrant pain, dark urine, pale stools, pruritus, and significant weight loss. She reported a prior admission for cholangitis, treated with antibiotics. Examination revealed stable vital signs, icteric sclerae, right upper quadrant tenderness, and scratch marks on the skin. Laboratory investigations showed elevated liver enzymes and hyperbilirubinemia (total bilirubin = 26 mg/dL, direct bilirubin = 20.5 mg/dL). Initial imaging studies, including ultrasound and CT, suggested a hydatid cyst of the liver. However, MRCP revealed dilated intrahepatic and extrahepatic bile ducts, consistent with a Type IV-A choledochal cyst. The patient underwent cholecystectomy, extrahepatic bile duct excision, and Roux-en-Y cysto-jejunostomy. Histopathological analysis confirmed the diagnosis without evidence of malignancy. She recovered uneventfully, with no complications reported during a 6-month follow-up.

Discussion: This case highlights the diagnostic challenges in differentiating choledochal cysts from hydatid cysts, particularly in endemic regions. The use of MRCP was pivotal in achieving an accurate diagnosis and guiding definitive management. Early surgical intervention minimized the risks of complications and malignancy.

Conclusion: Type IV-A choledochal cysts can present atypically, mimicking hydatid cysts. Advanced imaging, especially MRCP, is critical for accurate diagnosis and management.

Background and introduction: Reduction mammaplasty surgery constitutes one of the plastic surgery procedures with the greatest impact on patients' quality of life. It is necessary to ensure an appropriate mammary contouring. Over time, various techniques have been proposed to overcome these problems, based mainly on the use of dermal, dermo fascial, or myoglandular flaps. In this case report we describe the use of a laterally vascularized dermal flap to provide better breast contouring.

Case presentation: A 34-year-old female patient underwent reduction mammaplasty surgery using a dermal flap to reshape her breast profile. The flap was set up with a lateral base, degreased and anchored with a dermal loop to the pectoralis muscle to ensure adequate breast contouring.

Clinical discussion: An optimal aesthetic result was obtained with contour shaping of the medial quadrants and a reduction in bulging of the lateral quadrants, with increased satisfaction of the patient's breast aesthetics.

Conclusion: The use of dermal flaps for breast contouring in reduction mammaplasty is described in various modalities in the literature. The use of a laterally based dermis allows the bulging of the lateral quadrants to be reduced and the contouring of the medial quadrants to be redefined with a quick and easy technique that also allows for a more stable result and greater patient satisfaction.

Introduction: Coarctation of the aorta is a congenital narrowing of the thoracic aorta associated with hypertension and significant pressure gradients across the coarctation site. Coarctoplasty by percutaneous approach is the preferred method of treatment. However, complications like stent dislodgement may result and must be immediately managed to prevent adverse outcomes.

Case presentation: A 29-year-old male, who had previously undergone a mitral valve replacement, presents with exertional dyspnea and systemic hypertension. Blood pressure measurements revealed a 50 mmHg gradient between the upper and lower extremities. Imaging modalities revealed severe CoA with a 45 mmHg peak systolic gradient. During percutaneous coarctoplasty with a balloon-expandable stent, improper use of the yellow applicator resulted in stent dislodgment. A stent was partially deployed and, after post-dilation, the stenosis was resolved. The patient recovered uneventfully and remained asymptomatic with no evidence of recoarctation at six-month follow-up.

Discussion: Coarctoplasty with stent implantation is a relatively safe yet effective treatment for CoA. However, this technique may be complicated by stent dislodgment due to technical error or device-related issues. The major cause of stent dislodgment in the present case was considered failure to use the yellow applicator. Fortunately, prompt corrective measures allowed uneventful deployment of the stent without major complications.

Conclusion: Strict adherence to procedural protocols is critical for minimizing complications and achieving optimal outcomes on CoA interventions.

Background: Primary lung adenocarcinoma can sometimes present atypically, mimicking interstitial lung disease (ILD), and posing significant diagnostic challenges. Such presentations often lead to misdiagnoses, delaying appropriate treatment.

Case presentation: A 35-year-old female non-smoker presented with a six-month history of progressive cough, mild hemoptysis, fatigue, and exertional dyspnea, with no associated weight loss. Imaging studies revealed diffuse ground-glass opacities and interstitial infiltrates, while pulmonary function tests were consistent with interstitial lung disease. Despite these findings, bronchoscopy results were normal. A definitive diagnosis was ultimately made through a biopsy, which identified a moderately to poorly differentiated adenocarcinoma with acinar and micropapillary features.

Discussion: This case highlights the diagnostic complexity when lung adenocarcinoma presents atypically, mimicking ILD. Conventional diagnostic tools, such as imaging and pulmonary function tests, may overlap with ILD findings, leading to misdiagnoses. Early consideration of malignancy and the use of invasive diagnostic procedures, such as biopsy, are essential for distinguishing between ILD and malignancy in atypical cases.

Conclusion: This case underscores the importance of maintaining a high index of suspicion for malignancy in atypical ILD presentations. Early invasive diagnostic techniques are crucial for achieving a timely and accurate diagnosis, ultimately improving patient outcomes.

Introduction and importance: Splenic artery aneurysm is extremely rare but potentially life threatening disease which poses great challenge in diagnosing due to non-specific nature of clinical presentation. Rarely, it presents with upper gastrointestinal bleeding i.e. hematemesis and melena.

Case presentation: A 58-years-old male presented with three and half month history of black tarry stool and abdominal pain, who was initially diagnosed as erosive gastritis and managed with antacids and PPI. After few months of resolution of symptoms, he experienced light-headedness, severe epigastric pain and syncopal episodes. That led to further imaging study which revealed splenic artery aneurysm with celiac artery dissection for which he underwent splenectomy after failure two repeat embolization intervention. Postoperative recovery was smooth, and he remained asymptomatic on follow-up.

Clinical discussion: Though, there is constant risk of SAA to rupture, in our case pressure exerted by aneurysm on celiac artery caused dissection and upper GI bleeding. Endovascular technique is preferred technique but surgery reserved as options in case of failure.

Conclusion: This case highlights the complexities in diagnosing and treating life threating splenic artery aneurysm with celiac artery dissection.

Introduction: Soft tissue defect in the lower limb presents as a difficult reconstructive challenge. Cross-leg flap was routinely used in the past for the salvage of the lower limb but is seldom used nowadays due to advances in microsurgical procedures.

Case presentation: We present a case of an 18-year-old male who presented with a complex soft tissue defect of 25 × 10 cm on the anterolateral aspect of the right leg following a motor vehicle accident. The defect was unsuitable for local flaps due to the unavailability of healthy tissue or free tissue transfer as no suitable recipient vessels were available for microvascular anastomosis in the vicinity. After serial debridement, the patient was planned for a distal cross-leg fasciocutaneous sural artery flap from the left leg to cover the defect. The cross-leg flap was elevated over the posterior aspect of the left leg with 2 delay procedures over 2 weeks and inset was done over the defect with an intact pedicle. External fixators were applied to fix the legs in a cross-leg position. Finally, the flap was detached after 3 weeks.

Discussion: Cross-leg flap has a clear role in reconstructive trauma surgery because of its simplicity, good-quality coverage, and minimal cosmetic disadvantage. We, therefore, advise its application in cases when microvascular competence or operating room time is limited, or the injury is not suitable for local tissue transfer.

Conclusion: A pedicled cross-extremity flap can be successfully employed for the salvage of the limb in a resource-limited setting.

Introduction: Congenital pyloric web or diaphragm are rare causes of Gastric Outlet Obstruction (GOO) after infancy, representing approximately 1 % of gastrointestinal obstructions. While it typically presents in the neonatal period with nonbilious vomiting, delayed diagnosis beyond infancy is exceptionally rare.

Presentation of the case: An 11-year-old girl with presented with one-month history of postprandial vomiting. Her medical history was unremarkable and clinical examination and laboratory investigations were normal. A barium meal X-ray revealed narrowing at the gastric outlet. Endoscopy showed severe pyloric narrowing with undigested food in the stomach. Due to the severity of the stenosis, the endoscope could not traverse and surgical intervention was required.

Discussion: Pyloric webs and diaphragms are considered rare causes of congenital GOO. Confirmation of the diagnosis requires an upper contrast study or endoscopy. Gastric outlet obstruction can manifest with various symptoms. The clinical onset varies depending on the underlying cause. We conducted a systematic literature review of all case reports and series focused on GOO patients over 10 years old due to webs or diaphragms. The review reveals that symptoms are varied and may persist for years before diagnosis due to the rarity of these anomalies and their nonspecific presentations. This review highlights the importance of follow-up period after treatment due to the risk of recurrence.

Conclusion: This case emphasizes the importance of conducting endoscopy or abdominal X-rays with barium meals in evaluating persistent gastrointestinal symptoms, particularly in female patients.

Introduction and importance: The branchial or pharyngeal apparatus, crucial in embryological development, consists of clefts, arches, pouches, and membranes. Anomalies arising from this apparatus particularly involving the second branchial arch, are rare. Among these anomalies, complete second branchial cleft fistulas, with both external and internal openings, are exceptionally uncommon. This case report presents such a rarity in a fifteen-year-old boy, highlighting the clinical presentation, diagnostic approach, surgical management, and outcome.

Case presentation: A fifteen-year-old boy presented with a history of mucoid discharge from an opening on the lateral aspect of the right neck, noticed since birth. Clinical examination revealed a pinhole opening along the anterior border of the sternocleidomastoid muscle. Imaging studies confirmed the diagnosis of a complete second branchial cleft fistula, extending from the right lateral neck to the right tonsillar fossa. Surgical excision using a stepladder approach was performed under general anesthesia, leading to complete resolution of symptoms.

Clinical discussion: Complete second branchial cleft fistula is a rare entity. The diagnosis requires thorough history and examination, imaging, biopsy and surgical excision along with certain period of folllow-up.

Conclusion: Complete second branchial cleft fistulas are exceedingly rare congenital anomalies, typically presenting with mucoid discharge from a neck opening since birth. Diagnosis involves clinical examination and imaging studies, such as sinography with water-soluble contrast. Surgical excision, often via a stepladder approach, remains the mainstay of treatment, resulting in favorable outcomes. Early recognition and prompt intervention are essential for optimal management.