International Journal of Surgery Case Reports最新文献

Introduction: Penetrating cardiac injury (PCI) is rare and life-threatening, with complications that include hemorrhage, tamponade, arrhythmia, and cardiac arrest. Needle insertion into the heart is infrequently reported; to our knowledge, only one case of recurrent self-insertion has been described.

Case presentation: A 29-year-old man with bipolar I disorder and a prior sternotomy for foreign-body removal presented after a second suicide attempt within two years, having self-inserted multiple needles through the chest and abdomen. Chest radiography showed three metallic densities in the left hemithorax and one in the abdominal wall. Transthoracic echocardiography demonstrated a linear metallic echo within the left ventricle (LV) near the apex. Computed tomography confirmed three metallic densities in the left thorax, one penetrating the LV to a depth of 30 mm. Median sternotomy was performed, and one needle was removed from the LV. After recovery, the patient was transferred to a psychiatric hospital for further inpatient treatment.

Discussion: Intentional cardiac injury by needle insertion is extremely rare and poses diagnostic and therapeutic challenges. Early imaging and prompt surgery are essential to reduce morbidity and mortality. A multidisciplinary plan, including psychiatric evaluation and follow-up, is required to prevent fatal outcomes and recurrence.

Conclusion: This study describes the successful management of a penetrating cardiac injury in a patient with a prior sternotomy.

Background: Incisional hernia is a common complication of abdominal surgery, characterized by protrusion of abdominal contents through a weakened incision site. Although laparoscopic IPOM repair reduces recurrence rates compared to open repair, it carries a risk of rare complications, such as erosion of prosthetic mesh.

Case presentation: We describe a 50-year-old woman with a history of scleroderma who presented with chronic abdominal pain, intermittent diarrhea, and fullness in the right lower quadrant. Imaging evaluation, including CT scan and colonoscopy revealed erosion of prosthetic mesh into the cecum, which was confirmed during exploratory laparotomy. The patient underwent a segmental colectomy with ileocolic anastomosis and recovered without postoperative complications.

Discussion: Mesh erosion is an uncommon but serious complication of laparoscopic IPOM repair, potentially influenced by impaired wound healing in connective tissue disorders such as scleroderma. This case highlights the importance of careful postoperative monitoring and timely recognition of mesh-related complications.

Conclusion: This case emphasizes the need for increased awareness of the risk of prosthetic mesh erosion following intraperitoneal mesh repair and underscores the urgent need for further research into its long-term outcomes and complications.

Introduction: Takayasu arteritis (TAK) is a rare large-vessel vasculitis that may cause critical supra-aortic stenosis and cerebral ischaemia. Guidance on the optimal sequencing of biologic therapy and open revascularisation remains limited.

Case presentation: A 27-year-old woman with a decade-long history of systemic symptoms and limb claudication developed headaches, dizziness and presyncope. Examination showed asymmetric blood pressure, diminished pulses and widespread bruits. CT angiography demonstrated diffuse aortic wall thickening with critical bilateral carotid stenosis; PET/CT confirmed active vasculitis. High-dose methylprednisolone was started, followed by tapering prednisolone and methotrexate. Persisting symptoms and critical carotid disease prompted starting tocilizumab at week 4, achieving remission at week 10. Three months following therapy initiation, an ascending aorta-to-left carotid bypass with a 12-mm graft was performed via partial upper sternotomy without complications. Neurological symptoms resolved and cerebral flow normalised; she remains relapse-free two years later on tocilizumab, methotrexate and low-dose prednisolone.

Clinical discussion: Intravenous tocilizumab rapidly induces remission in TAK and shows lower relapse rates than the subcutaneous route. For long-segment supra-aortic lesions in TAK, open bypass avoids inflamed segments and offers greater durability than endovascular techniques, but should be scheduled during metabolic quiescence to minimise restenosis. This case illustrates the benefit of combining IL-6 blockade with timely surgery.

Conclusion: Open surgical revascularisation offers superior long-term patency in extensive Takayasu arteritis, and can be safely performed once remission has been induced with tocilizumab in refractory disease. Multidisciplinary coordination of biologic therapy and open revascularisation may optimise neurological and vascular outcomes in complex supra-aortic TAK.

Introduction: Traumatic entrapment of the median nerve within the elbow joint is a rare condition and primarily affects children and adolescents. It may occur following elbow dislocations or fracture-dislocations.

Presentation of case: A 33-year-old woman presented one week after sustaining an elbow dislocation, reporting severe pain and symptoms of median nerve dysfunction. After the failure of conservative treatment, surgical exploration, performed the following week, revealed a type III intra-articular entrapment (neve looped inside the joint). Nerve decompression was successfully executed, and no postoperative complications were observed. At the two-year follow-up, the patient reported no pain and had returned to work with minimal functional limitations.

Discussion: To date, just over 50 cases of traumatic median nerve entrapment have been documented in the literature. It is typically classified into four anatomical types, with types I and II being the most prevalent. In a literature review, we found only seven reported cases of type III entrapment in patients between 4 and 18 years of age. Therefore, this may represent the first reported case of type III entrapment in a patient older than 18 years.

Conclusion: This report describes a rare case and highlights that achieving a favorable outcome in cases of intra-articular nerve entrapment depends on early clinical suspicion, timely diagnosis, and prompt surgical intervention.