International Journal of Surgery Case Reports最新文献

Introduction: Hyperacute rejection leading to hepatic necrosis or intrahepatic bile duct stricture in ABO incompatible living-donor liver transplant (ABO-i LDLT) has been reported many times. With the advent of rituximab, the incidence of these complications has decreased significantly. However, consecutive biliary disruption after ABO-i LDLT has rarely been reported.

Presentation of case: A female in her 50s with blood type A was admitted to our hospital for ABO-i LDLT due to failure of a graft (refractory ascites [Child-Pugh C(10), MELD 9]) that had been primarily transplanted 20 years ago from her ABO-identical father. Since the living donor was her husband with blood type B, rituximab was administered for ABO-i re-LDLT. After the LDLT, the patient recovered quickly despite bile leakage at the biliary anastomosis. Subsequently, the bile duct of the graft liver was serially disrupted with a bile lake, which required multiple instances of biliary drainage. A liver biopsy was performed and did not show any C4d staining on 195 post-transplant days. The patient ultimately developed sepsis due to cholangitis and expired at 11 months after the re-LDLT and finally C4d was positive on post-mortem biopsy.

Discussion: Advances in ABO-i LDLT, particularly with rituximab, have reduced complications, but consecutive bile duct disruption remains challenging. Despite positive donor-specific antibody, early rejection markers were absent, suggesting complex mechanisms of complication.

Conclusion: We herein report a rare case as an important observation that may aid in preventing and treating potentially fatal complications after ABO-i LDLT.

Introduction: Neuroendocrine neoplasm (NENs) make up approximately 2-3 % of gallbladder malignancies, while only 0.5 % of all NENs develop in the gallbladder. Most Gallbladder neuroendocrine neoplasms (GB-NENs) are discovered incidentally during pathological examinations post-cholecystectomy.

Case presentation: 70-year-old male presents with an incidentally discovered 2.2 cm enhancing intraluminal soft tissue mass on abdominal CT scan. The mass demonstrates restricted diffusion on MR imaging, concerning for gallbladder malignancy. Radical cholecystectomy, confirms primary gallbladder neuroendocrine tumor (GB-NET). No adjuvant therapy was recommended at multidisciplinary cancer conference review. The patient is currently disease free at 18 months follow up.

Discussion: The management of GB-NEN remains challenging, due to the lack of specific clinical manifestations and typical imaging features preoperatively. GB-NENs are usually asymptomatic, and the paucity of reported imaging characteristics makes prospective diagnosis of GB-NENs challenging. GB-NEN tend to be larger in size, demonstrating well defined, intact mucosa, with a thick rim of hyperintensity on diffusion weighted images (DWI). Distinguishing between gallbladder neuroendocrine carcinoma (GB-NEC) and gallbladder neuroendocrine tumor (GB-NET) on pathologic evaluation is essential in developing a treatment plan. GB-NETs have superior survival compared to GB-NECs. GB-NETs can be managed utilizing a cholecystectomy with portal lymphadenectomy +/- segment 4b/5 liver resection.

Conclusion: GB-NETs may achieve curative resection, if identified at an early disease stage.

Introduction and importance: Congenital epulis is a rare and benign newborn tumor. There are some papers on this entity; however, very few reports focus on its macroscopic view.

Case presentation: We present a newborn girl with multiple congenital epulis of the mandibular and maxillary alveolar ridges who underwent a successful surgical intervention in a resource-limited setting.

Clinical discussion: Congenital epulis is frequently diagnosed by histopathological examination, although sonography could be helpful before birth. Despite the benign nature of the disease, immediate intervention is often required as it can prevent feeding and cause asphyxia in neonates. Surgical excision is the standard treatment.

Conclusions: Congenital epulis can be identified clinically shortly after birth. They cause a substantial surgical challenge due to multiple or large lesions and problems with breathing and feeding. Surgical repair must be performed as early as possible.

Introduction: Proximal humerus Salter-Harris type II fractures combined with ipsilateral shoulder dislocation in children are extremely rare injuries. Therefore, the best prescribed treatment has not yet been established.

Case presentation: A case of a 3-year-old boy who sustained an epiphyseal separation of the right proximal humerus (Salter-Harris type II) and an ipsilateral anterior dislocation of the glenohumeral joint following a road traffic accident. Closed reduction of both injuries under the C-arm intensifier failed. Open reduction was performed through an anterior deltopectoral approach with two 1.6 mm Kirschner wires fixation. Outcome was good with full range of motion of the shoulder.

Clinical discussion: Traumatic proximal humeral physis fracture associated with shoulder dislocation is a rare and severe injury. Optimal management is still debated, non operative or surgical treatment (open or closed reduction with osteosynthesis) being advocated as the most preferred approach. Open reduction should be performed in patients whose closed reduction has failed, due to soft tissue entrapment.

Conclusion: Proximal humerus fractures combined with ipsilateral shoulder dislocation in children under five years are rare but do occur. Open reduction followed by pinning is a good therapeutic option with good outcome when closed reduction failed.