International Journal of Surgery Case Reports最新文献

Introduction and importance: Acquired Hemophilia A (AHA) is a rare autoimmune bleeding disorder caused by autoantibodies against factor VIII. Diagnosis is often delayed when confounding factors coexist.

Presentation of case: We report a 70-year-old male with peripheral arterial disease presenting with critical limb ischemia, severe anemia, and prolonged APTT. Investigations revealed factor VIII inhibitor, concomitant factor XII deficiency, and lupus anticoagulant positivity.

Clinical discussion: The combination of FXII deficiency and lupus anticoagulant created significant diagnostic confusion, as both are associated with prolonged APTT but not with bleeding. This overlap risked masking the hemorrhagic tendency of AHA. Management required bypassing agents, surgery, immunosuppressive therapy with corticosteroids and rituximab, and multidisciplinary care.

Conclusion: This case highlights the importance of considering acquired hemophilia A in unexplained bleeding with prolonged APTT, especially when coexisting conditions such as FXII deficiency and lupus anticoagulant may obscure diagnosis.

Introduction: Obturator hernia is a rare cause of bowel obstruction, predominantly affecting elderly women. Its non-specific symptoms often delay diagnosis, increasing the risk of complications.

Case presentation: We report the case of an 86-year-old woman presenting with signs of intestinal obstruction. CT imaging identified a strangulated right obturator hernia without ischemia, managed successfully via laparotomy. This case report has been reported in line with the SCARE 2025 checklist (Kerwan et al., 2025 [1]).

Discussion: While laparoscopy is increasingly used in selected cases, open surgery remains appropriate in emergencies or when technical conditions are unfavorable. Our decision for laparotomy was guided by marked bowel distension and respiratory constraints.

Conclusion: This case highlights the diagnostic challenge of obturator hernia, particularly in elderly patients with prior hernia history, where atypical presentations may mimic other conditions. Tailored surgical strategies, guided by clinical and intraoperative findings, are essential to optimize outcomes in such high-risk cases.

Introduction and importance: Inguinal hernia surgery is common worldwide. A giant inguinal hernia occurs when the hernia extends below the midpoint of the thigh, making reduction into the abdominal cavity challenging and posing significant operative and postoperative risks.

Case presentation: We report a case series of five male patients, aged 51-75 years, with giant inguinal hernias treated between January 2024 and January 2025. Four patients presented electively and one emergently with strangulation. All hernias extended below the midpoint of the thigh. Open surgical repair was performed in all cases, with reduction via an abdominal incision above the inguinal crease. The hernia contents included small and large bowel loops with omentum. In one case, the inferior epigastric artery was ligated to facilitate reduction.

Clinical discussion: We report a case series of five male patients, aged 51-75 years, with giant inguinal hernias treated between January 2024 and January 2025. Four patients presented electively and one emergently with strangulation. All hernias extended below the midpoint of the thigh. Open surgical repair was performed in all cases, with reduction via an abdominal incision above the inguinal crease. The hernia contents included small and large bowel loops with omentum. In one case, the inferior epigastric artery was ligated to facilitate reduction.

Conclusion: Giant inguinal hernias require individualized surgical planning. Careful reduction, sac excision, and reinforcement with mesh can achieve good outcomes. Ligation of the inferior epigastric artery may aid reduction in specific cases. A better understanding of socioclinical factors leading to delayed presentation may improve earlier detection and intervention.

Introduction and importance: Hydatid disease predominantly involves the liver and lungs, whereas intramuscular localization is exceedingly rare, particularly in the paraspinal region.

Case presentation: A 57-year-old man with surgically treated pulmonary and retroperitoneal hydatid cysts in childhood presented with chronic thoracolumbar and left intercostal radicular pain. Imaging showed a multiloculated cystic lesion in the left paravertebral muscles at D11-D12 and D12-L1 with extension into the corresponding neural foramina. He underwent surgical excision and histopathology confirmed Echinococcus granulosus infection. Postoperative management included albendazole therapy. At 18 months, MRI showed no recurrence, and the patient was asymptomatic with no radiologic disease. Given the risk of late relapse, long-term follow-up is planned.

Clinical discussion: Muscular hydatidosis can present long after treated visceral disease. Diagnosis depends on clinical suspicion supported by serology and imaging, particularly in endemic regions. Definitive management is meticulous surgical excision with adjunctive antihelminthic therapy to minimize recurrence. Because primary muscular involvement is rare, misdiagnosis is common, necessitating heightened clinical vigilance. In our case, no recurrence was detected at 18 months. However, late relapse remains possible, warranting vigilant long-term surveillance with periodic imaging.

Conclusion: Hydatid disease should be included in the differential for paravertebral masses, even after treated visceral disease. This case highlights the need for long-term surveillance and a multidisciplinary approach. Early recognition and appropriate therapy are essential to prevent complications and recurrence.

Introduction and importance: Chyle leak is an uncommon complication of abdominal surgeries. There are no reported cases of a chyle leakage following an omental patch repair for a perforated gastric ulcer before. A chyle leak from such a case however can successfully be treated conservatively.

Case presentation: We report an unusual case of a 57-year-old male presented with a perforated gastric ulcer who underwent a laparotomy and omental patch repair, which subsequently presented with a chyle leak from his abdominal wound.

Clinical discussion: Post operative chyle leak usually occurs from the intraoperative disruption of the thoracic duct, cisterna chyli, or major tributaries of the lymphatic system, and hence can also occur following abdominal and retroperitoneal surgeries. Chyle leakage is not one of the known postoperative complications following an omental patch repair. As chyle leak after omental patch repair has not been reported before, we sought to ascertain the causes. This case was successfully treated conservatively. This patient had a low volume chyle leak. The main stay of conservative treatment for a low volume chyle leak is to reduce chyle production via nutrition optimisation. Literature found that a more conservative approach to management of a chyle leak can be very successful. We discuss the conservative management of the chyle leak with intraabdominal drainage and a very low-fat diet.

Conclusion: A chyle leak following an omental patch repair for a perforated gastric ulcer is an unusual post-operative complication. It can be treated conservatively successfully provided the chyle leak maintains at a low volume.

Introduction and importance: This case report describes a rare complication of intraocular lens (IOL) opacification in a 76-year-old female patient after age-related cataract surgery in the right eye. Although uncommon, IOL clouding can significantly impair postoperative visual acuity, necessitating surgical intervention. Therefore, choosing the right type of artificial crystal is extremely important.

Case presentation: The patient presented with progressive blurred vision in the right eye for one year. We confirmed the diagnosis and identified the underlying cause after thoroughly excluding other potential influencing factors and make a distinction from congenital cataracts. Subsequently, surgical intervention was performed on the right eye, involving removal of IOL and the re-implantation of new IOL. It resulted in significant improvement in the patient's postoperative vision.

Clinical discussion: Clouding of the IOL following cataract surgery is characterized by a reduction in lens transparency after implantation. Although relatively uncommon, this complication can significantly impair vision. The etiology of IOL opacification post-surgery primarily encompasses material-related factors, surgical factors, patient-specific factors, and other miscellaneous factors. This case underscores the critical importance of evidence-based IOL selection in cataract surgery to mitigate vision-compromising postoperative complications.

Conclusion: With the advancement of surgical techniques and the introduction of new materials, the incidence of IOL opacification following cataract surgery has significantly decreased. Looking ahead, we will prioritize the use of hydrophobic acrylic IOLs or novel anti-calcification IOLs in future surgeries. This strategic choice aims to further minimize the impact of long-term complications on visual acuity post-cataract surgery.

Introduction: Children with congenital anomalies are at increased risk of childhood malignancies. Among these, children with nervous system and urinary system anomalies have the highest incidence rate of cancer. This is a report of an intrarenal Wilm's tumor in a patient with spina bifida.

Case presentation: A 4-month-old male baby with a repaired lumbosacral myelomeningocele presented with right flank swelling. At presentation, a firm, slightly mobile, and nontender right flank mass was noted. Abdominopelvic ultrasound performed at a neonatal age revealed an 8 mm right renal cyst at the lower pole without septa or mural nodules. Magnetic resonance imaging performed at his recent presentation was suggestive of Wilm's tumor. The histopathology revealed cystic, partially differentiated nephroblastoma with negative lymph nodes. It's a SIOP stage 1 low-risk tumor that doesn't deserve adjuvant chemoradiotherapy. He has been on follow-up for over a year, and no evidence of local recurrence or metastatic growth.

Discussion: Wilms' tumor is the commonest renal tumor of childhood, commonly seen in preschool children. Though it usually happens sporadically, some chromosomal anomalies are known to be associated with it. Patients with congenital anomalies, including spina bifida, are known to have an increased risk of Wilm's tumor. Hence, they need a thorough investigation whenever a visceral lesion is found incidentally, even if they are asymptomatic.

Conclusion: An intrarenal Wilms tumor can appear synchronously with spina bifida, and a high index of suspicion should be maintained to rule out malignancy when we encounter a young patient with spinal dysraphism and a visceral lesion.

Introduction and importance: Ameloblastic fibroma (AF) is a benign mixed odontogenic tumor composed of epithelial and mesenchymal tissues. It accounts for approximately 1.5-4.5 % of all odontogenic tumors and is most commonly diagnosed during the first and second decades of life. Due to documented cases of malignant transformation, the optimal therapeutic approach for AF remains a subject of debate.

Case presentation: A 15-year-old female patient presented with pain, swelling, and purulent discharge in the right posterior mandible. Panoramic radiography revealed a unilocular radiolucent lesion associated with tooth 48. The patient had no significant medical history.

Clinical discussion: An incisional biopsy was performed with the presumptive diagnosis of odontogenic keratocyst, followed by decompression tube placement. Histopathological examination confirmed the diagnosis of ameloblastic fibroma. Given the patient's age and the low likelihood of malignant transformation, a conservative treatment approach was adopted, consisting of enucleation, curettage, peripheral osteotomy, and extraction of retained teeth. Due to the compromised lingual and vestibular cortices at the mandibular basal border-observed on computed tomography (CT)-a reconstruction plate was placed to prevent pathological fracture.

Conclusion: AF is a rare, often asymptomatic odontogenic tumor. Therapeutic management remains controversial due to its recurrence rate (18.3 %-43.5 %) and potential for malignant transformation (reported in one-third of cases). In this case, at the 9-month follow-up, the patient exhibited preserved mandibular function, remained asymptomatic, and showed no clinical or radiographic evidence of recurrence. Conservative treatment with rigorous long-term monitoring may be the preferred approach for young patients to optimize functional outcomes and quality of life. No generative artificial intelligence (AI) tools were used in the conception, design, data collection, analysis, or interpretation of the research presented in this manuscript. Furthermore, no AI-assisted technologies were employed in the drafting, editing, or revision of the manuscript.

Introduction and importance: Invasive moles (IMs) are a rare form of gestational trophoblastic disease (GTD) characterized by molar tissue made up of hydropic villi with an overgrowth of trophoblastic cells. These can penetrate the myometrium or uterine vessels in women of reproductive age. Its occurrence in postmenopausal women is exceedingly rare, and even more unusual when arising after a heterotopic pregnancy. Such presentations pose significant diagnostic and therapeutic dilemmas, particularly in resource-limited settings where access to advanced diagnostics and oncology services may be constrained.

Case presentation: We report a rare case of invasive mole in a 48-year-old woman, 3 years postmenopausal, from Northern Tanzania. She presented to our tertiary hospital with a 3-month history of lower abdominal pain, abdominal distension, and per vaginal bleeding. The patient had a prior history of molar evacuation and left salpingectomy for a heterotopic ectopic pregnancy. Post-evacuation, she did not undergo serial monitoring of serum β-hCG levels. Abdominal ultrasonography revealed a bulky uterus with a heterogeneous, myometrium-infiltrating mass, raising suspicion of uterine choriocarcinoma. In view of the findings and clinical condition, a total abdominal hysterectomy was performed. Histopathological examination confirmed an invasive mole, stage I, with a FIGO prognostic score of 7. Despite counseling, the patient declined adjuvant chemotherapy.

Clinical discussion: In this rare case report, we discuss the rarity of invasive mole in a postmenopausal woman after heterotopic pregnancy and underscores the importance of β-hCG surveillance for early detection.

Conclusion: This case highlights the diagnostic and therapeutic challenges of invasive mole in a postmenopausal woman after heterotopic pregnancy in a resource-limited setting. The absence of post-evacuation β-hCG surveillance contributed to delayed recognition. Clinicians should maintain a high index of suspicion and emphasize the importance of hCG monitoring for early detection and optimal management of GTN. Also should maintain a high index of suspicion for GTN in women with abnormal bleeding even after menopause.