International Journal of Surgery Case Reports最新文献

Introduction and importance: Oral squamous cell carcinoma (SCC) is exceptionally rare in patients under 40, with chronic sun exposure being a primary risk factor. This report presents a highly unusual case of pediatric SCC of the upper lip in the Middle East, notable for its atypical location and absence of all conventional risk factors.

Presentation of case: A 13-year-old, otherwise healthy Syrian boy presented with a progressive swelling on his upper lip. The lesion appeared 1 week after the surgical excision of a traumatic scar that had persisted for 6 years. The swelling failed to respond to conventional treatments over a 2-month period. Histopathological examination confirmed poorly differentiated squamous cell carcinoma.

Clinical discussion: The patient was treated with wide surgical excision employing 1 cm safety margins, followed by reconstruction using an Abbe flap and adjuvant chemoradiotherapy. Over a 2-year follow-up period, no recurrence was observed, with excellent outcomes. This case is exceptional: it contrasts with the typical presentation of lip SCC in the elderly and its predominant occurrence on the lower lip. Furthermore, the development of SCC at the site of a long-standing scar highlights potential malignancy arising from chronic inflammation and trauma.

Conclusion: This report documents a rare instance of pediatric upper lip SCC, underscoring the importance of considering malignancy in persistent or evolving lesions, even in young patients without traditional risk factors. It emphasizes that chronic scarring should be recognized as a potential risk factor for carcinogenesis.

Introduction and importance: Adult intussusception is a rare clinical entity, accounting for less than 5% of all cases and often associated with an underlying lesion. Inflammatory fibroid polyps (IFPs) are rare benign mesenchymal tumors that may act as a lead point for intussusception, most frequently in the small intestine. Herein, we report the case of a 52-year-old woman presenting with ileocecal intussusception secondary to an IFP.

Case presentation: A 52-year-old woman presented with intermittent abdominal pain and symptoms of subacute obstruction. Imaging revealed an ileocolic intussusception due to a polypoid ileal lesion. Laparoscopic ileocecal resection was performed with primary ileocolic anastomosis. Histopathological analysis confirmed the lesion as an inflammatory fibroid lesion. The postoperative course was uneventful, corresponding to Clavien-Dindo Grade 0. The patient remained symptom-free at 6 months of follow-up.

Clinical discussion: IFPs most often arise in the stomach and small intestine. In the small bowel, IFPs can serve as a lead point for intussusception, but ileocecal presentations remain uncommon. The laparoscopic approach is safe and provides excellent visualization and is associated with reduced pain and faster recovery. Complete resection of IFPs is curative with rare recurrence rates. Definitive diagnosis relies on histopathology and immunohistochemistry.

Conclusion: This case highlights the diagnostic challenges of adult intussusception, particularly when imaging is inconclusive. IFPs should be considered as a differential diagnosis. Moreover, it underscores the importance of laparoscopic surgical management both for diagnostic and therapeutic purposes.

Introduction and importance: Ewing sarcoma (ES) rarely arise in the toes, where nonspecific pain and swelling can mimic benign conditions, delaying diagnosis. Early recognition is critical because modern multimodal therapy can achieve limb preservation and high rates of disease control even at unconventional sites.

Case presentation: A healthy 22-year-old man developed progressive pain and swelling of the left hallux after partial nail excision for a presumed ingrown toenail. The wound failed to heal, evolving into a friable 3 × 3 cm dorsal mass. Radiography and MRI demonstrated an aggressive lytic lesion destroying the distal phalanx with soft-tissue extension. Incisional biopsy revealed small round blue cells strongly positive for CD99, and fluorescence in situ hybridization confirmed an EWSR1 rearrangement consistent with ES. Staging PET-CT showed no metastases. The patient received six cycles of vincristine-doxorubicin-cyclophosphamide alternating with ifosfamide-etoposide, followed by partial amputation of the distal phalanx with clear margins. Histology showed 98% tumor necrosis. Adjuvant chemotherapy was completed uneventfully. At 12-month surveillance, MRI and PET-CT showed no local recurrence or distant spread, and the patient had painless, functional ambulation.

Clinical discussion: This case highlights three key lessons: 1. Persistent or atypical digital lesions warrant oncologic evaluation. Soft-tissue masses that do not resolve after routine care should prompt advanced imaging and biopsy. 2. Molecular confirmation is pivotal. Detection of an EWSR1-FLI1 family fusion secures the diagnosis and guides therapy. 3. Neoadjuvant chemotherapy enables limb-sparing surgery. Pre-operative tumor shrinkage facilitated margin-negative resection while preserving toe function, and a 98% necrosis rate predicts favorable prognosis. Vigilant, long-term surveillance remains essential because ES can relapse late.

Conclusion: Ewing sarcoma of the great toe is exceptionally rare but can be successfully treated when identified early and managed with coordinated multimodal therapy. Clinicians should maintain vigilance for malignancy in non-healing digital lesions to ensure timely intervention and durable outcomes.

Introduction: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, particularly in low- and middle-income countries. Uterine atony is the most common etiology, while uterine rupture is less frequent but catastrophic. The coexistence of both conditions is rare and poses significant management challenges.

Case presentation: We report the case of a multiparous woman who developed massive PPH due to a combination of uterine rupture and refractory uterine atony. Despite maximal uterotonic therapy, uterine massage, and fluid resuscitation, bleeding persisted. Abdominal ultrasonography revealed intraperitoneal free fluid, consistent with intra-abdominal hemorrhage. The patient underwent an emergency total abdominal hysterectomy with bilateral salpingectomy. During resuscitation, uncrossmatched O Rh(+) blood was administered, followed by a massive transfusion protocol including whole blood, packed red cells, fresh frozen plasma, and platelets.

Discussion: This case underscores the importance of early recognition and rapid escalation in PPH management. Hysterectomy, although considered a last resort, was life-saving in this scenario. The use of uncrossmatched blood and structured massive transfusion protocol ensured timely correction of dilutional coagulopathy, hypocalcemia, and metabolic acidosis. Postoperative care required multidisciplinary collaboration, including obstetrics, anesthesiology, intensive care, and transfusion medicine, to achieve hemodynamic stabilization and recovery.

Conclusion: The rare coexistence of uterine rupture and refractory uterine atony highlights the need for prompt diagnosis, decisive surgical intervention, and balanced transfusion strategies. Multidisciplinary collaboration remains essential to optimize maternal outcomes in life-threatening obstetric hemorrhage.

Introduction and importance: Pseudotumor is a rare but serious complication of bleeding disorders. Its occurrence in Factor X (FX) deficiency is exceptionally uncommon. This report highlights a rare case of FX deficiency presenting as a large pseudotumor managed successfully by surgical excision.

Presentation of case: A 31-year-old man presented with a painful, progressively enlarging swelling over the left flank. Imaging revealed a large retroperitoneal mass with erosion of the left iliac bone. Coagulation studies showed prolonged prothrombin time and reduced FX activity, confirming FX deficiency. He was treated perioperatively with prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP), followed by open surgical evacuation of an organized hematoma. Postoperative recovery was uneventful, with no recurrence at 2-month follow-up.

Clinical discussion: Pseudotumor secondary to FX deficiency is extremely rare and can mimic soft tissue or bone malignancy. Early imaging and biopsy are essential for diagnosis. Definitive management involves factor replacement and surgical excision in large or symptomatic cases. In centers where FX concentrate is unavailable, PCC and FFP provide effective hemostatic coverage. This case underscores the importance of a multidisciplinary approach and resource-adapted management, which can achieve favorable outcomes even in low-resource settings.

Conclusion: Surgical excision with adequate perioperative PCC/FFP support remains a safe and effective strategy for large pseudotumors secondary to FX deficiency.

Introduction and importance: Foreign bodies (FBs) in the bladder can result from iatrogenic causes, migration from adjacent organs, penetrating injuries, or self-insertion. They serve as a nidus for calcification and stone formation. While bladder stones related to FBs are occasionally seen in adults, such cases are extremely rare in children.

Presentation of case: A 2.5-year-old girl (10 kg) presented with chronic irritability, abdominal pain, dysuria, and intermittent hematuria for 1 year, unresponsive to antibiotics and antipyretics. Examination was unremarkable, with a leukocyte count of 9900. Urinalysis showed microscopic hematuria and pyuria. Ultrasound revealed a 33 mm echogenic structure in the bladder, which was confirmed by a kidney, ureter, and bladder (KUB) radiograph as a calcified needle. No history of trauma or abuse was reported, and the child's development was normal. Open cystolithotomy was performed, successfully extracting the needle. Postoperatively, a urethral catheter was retained for 2 days and antibiotics were administered. The patient was discharged in good condition on day 3.

Clinical discussion: Bladder FBs in children are rare and present with nonspecific urinary symptoms. Imaging is essential for diagnosis, while management depends on the characteristics of the object and available resources. Endoscopic removal is ideal, but open surgery may be necessary in resource-limited settings or when dealing with rigid, sharp objects.

Conclusion: Prompt recognition and early imaging are essential in pediatric bladder FBs. Timely surgical management prevents avoidable complications that LMIC health systems are less equipped to manage once advanced disease develops.

Introduction and importance: Chest wall tumors pose complex challenges for both resection and reconstruction, particularly when involving extensive soft tissue or bony structures. Achieving stable, functional, and aesthetically acceptable outcomes requires a tailored surgical strategy based on the location and extent of the defect.

Case presentation: We report two male patients with chest wall tumors treated at a tertiary referral center in Vietnam. The first patient, with metastatic invasion of the sternum, underwent radical tumor resection, sternal reconstruction using titanium bars and Prolene mesh, and split-thickness skin grafting (STSG) for coverage. The second patient, presenting with a large dorsal soft tissue tumor, was managed with wide excision and reconstruction using a local rotational muscle flap. Both patients had uneventful recoveries and favorable functional and cosmetic outcomes.

Clinical discussion: The two cases highlight the versatility of reconstructive approaches in chest wall surgery. Rigid prosthetic materials such as titanium bars are effective for anterior defects involving skeletal structures, whereas local muscle flaps suffice for posterior soft tissue defects. STSG can complement flap or mesh-based reconstructions when deeper layers are adequately supported. The choice of reconstruction should consider anatomical location, defect complexity, and patient comorbidities.

Conclusion: Successful chest wall reconstruction after tumor resection relies on individualized surgical planning. A combination of prosthetic materials, flaps, and skin grafts can be tailored to achieve oncologic control, structural stability, and satisfactory recovery depending on the defect characteristics.

Background: Persistent vitellointestinal (omphalomesenteric) duct (VID) is an uncommon embryologic remnant that typically presents with painless bleeding, umbilical discharge, or mechanical small-bowel obstruction. Presentation with systemic sepsis or septic shock is exceedingly rare.

Case presentation: A 12-year-old male presented with 4 days of high-grade fever, progressive abdominal pain, bilious vomiting and hypotension. Imaging demonstrated high-grade small-bowel obstruction with a transition point in the mid-to-distal ileum. After failed conservative management, emergency laparotomy revealed a 1 × 3 cm tubular vitelline remnant with fibrous omental adhesion causing mechanical obstruction. Excision, release of the band, and primary ileal repair were performed. The patient stabilized postoperatively and was discharged on day 5.

Discussion: While VID anomalies classically cause localized gastrointestinal complaints, a systemic inflammatory response with circulatory collapse, consistent with septic shock, is uncommon and sparsely reported. Possible pathophysiologic mechanisms include bacterial translocation across ischemic or obstructed bowel, superinfection of a cystic remnant, or a non-infectious overwhelming inflammatory response to necrotic tissue. Because a clinical picture of presumed septic shock can obscure an underlying surgical cause, clinicians should consider VID anomalies in children with compatible abdominal findings. Prompt resuscitation, targeted evaluation for infection, early antimicrobial therapy when indicated, and timely surgical intervention are essential to prevent organ dysfunction.

Conclusion: VID can rarely present with systemic inflammatory response with circulatory collapse; recognition of this atypical pattern expedites lifesaving intervention.

Introduction and importance: Postoperative acute pancreatitis is uncommon after non-abdominal surgery and is mostly described after pediatric scoliosis correction in low body mass index (BMI) patients with intraoperative hypotension. Immediate onset after thoracic decompression in an obese adult with stable hemodynamics has not been reported.

Case presentation: A 51-year-old man (BMI: 33.7 kg/m²) underwent elective T9-T11 decompressive laminectomy for thoracic spinal cord compression. Surgery was performed prone on chest rolls with the abdomen free, and intraoperative blood pressure remained stable without vasopressors. Within minutes of uneventful extubation, he developed severe epigastric pain. Serum amylase and lipase were elevated, and contrast-enhanced computed tomography showed focal interstitial pancreatitis of the pancreatic head without gallstones. He was treated with bowel rest, intravenous fluids, and analgesia, with complete resolution of symptoms and normalization of pancreatic enzymes within 72 hours. Evaluation excluded biliary disease, alcohol misuse, hypertriglyceridemia, and drug or infection-related causes. Histopathology of the vertebral lesion confirmed tuberculosis, and he subsequently underwent staged thoracic fusion and instrumentation without recurrence of pancreatitis.

Clinical discussion: The abrupt timing strongly suggests an intraoperative or positioning-related insult despite preserved systemic pressures. Plausible mechanisms include transient splanchnic hypoperfusion, occult abdominal or pancreatic compression, and microcirculatory dysfunction.

Conclusion: Acute pancreatitis can arise immediately after thoracic spine surgery in the absence of classic risk factors. Vigilance for pancreatitis in patients with new-onset epigastric pain in the operating or recovery room enables timely diagnosis and supportive management.

Introduction and importance: Malignant chondroid syringoma (CS) is a sporadic skin tumor with slow growth and metastatic potential. Its presentation in the hand is uncommon, and limited cases have been reported in the literature. This case highlights an unusual presentation of malignant CS with delayed diagnosis, bone erosion, and distant metastases, adding to the sparse surgical literature on this tumor's aggressive behavior.

Case presentation: A 67-year-old male with a 5-year history of a progressively enlarging ulcerative lesion on his left hand, initially mistaken for an insect bite. The lesion caused pain, limited finger mobility, and led to fifth-digit loss. Imaging revealed soft tissue swelling, bone erosion, and multiple lytic lesions in bone. The patient underwent a ray amputation of the ring finger. Pathology confirmed malignant CS with positive S-100 and CA-9/19 markers. Despite chemotherapy and surveillance, the patient's condition worsened due to metastatic progression, resulting in death 2 years after the initial presentation.

Clinical discussion: Malignant CS of the hand is a rare tumor with sparse literature on its aggressive behavior. It may be easily misdiagnosed as a benign chronic lesion, leading to delayed treatment. Early recognition with aggressive evaluation could allow for timely wide excision with appropriate margins and surveillance, limiting metastasis and poor prognosis.

Conclusion: This case emphasizes the importance of considering malignant CS in chronic hand lesions with progressive bone involvement. Early diagnosis, wide local excision, and close monitoring are crucial due to the tumor's metastatic potential and poor prognosis, especially in larger or truncal tumors.