International Journal of Surgery Case Reports最新文献

Introduction: Echinococcus is a common infection in an endemic country like Bhutan. Mediastinal echinococcosis is rare. Although presentation due to a mediastinal echinococcal cyst is variable according to the cyst's location, a reaction due to rupture of the cyst and simultaneous reaction to an administration of antibiotics such as ceftriaxone can cause a diagnostic challenge. We present a rare case of a mediastinal echinococcal cyst that ruptured at the time of admission, causing a diagnostic challenge of the cause of the reaction.

Case presentation: A 54-year-old female patient presented with increasing shortness of breath, chest discomfort, and backache for a one-year duration. Computed chest tomography showed a cystic lesion in the right posterior mediastinum measuring 7.3 × 5.5 × 9.3 cm. The patient developed features of cyst rupture at the time of admission which was detected after the administration of antibiotics ceftriaxone to treat for suspected cyst infection. This caused a diagnostic challenge as the patient developed a reaction confusing the cause of the reaction.

Clinical discussion: Initially, an emergency chest x-ray showed the cyst rupture's features. An emergency right-sided chest tube drainage was placed. The patient underwent a right thoracotomy and peri-cystectomy with an uneventful post-operative recovery.

Conclusion: Any cystic lesion in the lung in an endemic region should prompt evaluation to rule out echinococcal cysts. Cyst rupture can occur suddenly and cause a reaction to the cyst fluid. Simultaneous antibiotic administration in a suspected cyst infection can miss a life-threatening ruptured echinococcal cyst, which is notorious for causing anaphylaxis.

Introduction: The eyelid is a common site for cutaneous tumors; however, tubular apocrine adenoma is a rare presentation. The clinical presentation is variable and surgical excision is effective with low risk for recurrence.

Presentation of case: We report a 40-year-old female with recurrent tubular apocrine adenoma of eyelid mimicking eyelid malignancy. Diagnostic incisional biopsy demonstrated dermal benign tubular-like proliferations lined by bilayer of apocrine epithelium within a background of hyalinized stroma.

Discussion: Isolated tubular apocrine adenoma of the eyelid is rare with individual cases being found in the literature. Previously reported recurring apocrine eyelid tumors were involving older patients than our case and the recurrence occurred within 2-3 years.

Conclusion: Our case is unique as the patient was younger and the recurrence occurred after a longer period. Our report provides insight into the clinical features, histopathologic characteristics and treatment of tubular apocrine adenoma of the eyelid.

Introduction and importance: Myiasis is an overlooked public health issue, with urogenital myiasis (UGM) being particularly rare, as evidenced by only 59 reported cases worldwide from 1975 to 2017. There is a notable scarcity of cases involving patients with prolonged catheter use related to SCI. The interaction of SCI with the complications associated with indwelling urinary devices is less frequently discussed in prior literature. Up to our best, it is the first case to be reported.

Case presentation: We report a case of a 40-year-old male with a spinal cord injury who developed UGM. He presented with multiple white maggots visible at the urethral meatus. He was on a long-term catheter due to urinary retention. There were moving maggots, which were manually removed.

Clinical discussion: This case underscores the risk of UGM in patients with urinary catheters, especially in underdeveloped areas where healthcare access may be restricted.

Conclusion: There is a critical need for education on UGM for at-risk groups, particularly those with indwelling urogenital devices, to ensure timely diagnosis and treatment and reduce the risk of complications.

Introduction: Large melanomas, while relatively uncommon, present significant diagnostic challenges due to their size and potential to mimic other malignancies, leading to delays in appropriate treatment. Initial misdiagnosis is a substantial concern, impacting patient outcomes. This case highlights the importance of immunohistochemistry in cancer diagnosis, and of appropriate therapeutic management, which here included excision surgery of the tumor mass.

Case presentation: This case report details a 75-year-old male who presented with a large mass on his left arm, initially hypothesized as a liposarcoma. Advanced imaging (MRI) and immunohistochemical analysis revealed the mass to be a superficial spreading melanoma expressing SOX10, PS100, Melan-A, HMB-45, and PRAME.

Clinical discussion: The patient later presented other skin lesions. As melanoma increase the risk of developing skin tumors, it is conceivable that the lesions may be interconnected. However, the lack of invasion beyond the dermis and the absence of metastasis suggest otherwise. The patient's psychological profile was investigated as another potential risk factor of cancer development. Inflammatory microenvironment was also observed, linked to the bacterial superinfection in the site of the initial tumor.

Conclusion: This case underscores the considerable diagnostic challenges caused by large melanomas, especially their potential for mimicking other malignancies. Biopsy, incorporating advanced imaging and immunohistochemistry, is crucial for accurate and timely diagnosis, enabling appropriate management and improving patient outcomes. This case emphasizes that, when possible, surgery should be performed regardless of the size of the tumor. Long-term surveillance is vital given the increased risk of subsequent skin cancers in such patients.

Introduction: Pleomorphic adenoma, the most common benign salivary gland tumor, typically occurs in the parotid region but can also arise in minor salivary glands. Its occurrence in the lateral tongue is infrequent, making this case the first reported from Ethiopia and the second in English literature.

Case presentation: We present an 11-year-old girl who underwent an excisional biopsy for a tongue swelling lasting 2 years. The swelling was located in the lateral middle third of her tongue. Post-operative follow-up at one year showed a smooth recovery.

Clinical discussion: Salivary gland tumors account for about 3 % of head and neck tumors, with 80 % being benign, primarily pleomorphic adenomas. While these tumors usually occur in the parotid gland, the tongue is rare, particularly in its base.

Conclusion: Although pleomorphic adenoma is rare in the lateral tongue, it should be considered in patients with tongue masses and when we do excision, it is best to consider the esthetics.

Introduction: Suture-mediated vascular closure devices have been widely used in catheter ablation, with 0.14-0.3 % incidence of pseudoaneurysm complications. Here, we report the only case at our institution to date of an infectious pseudoaneurysm caused by a suture-mediated vascular closure device following catheter ablation.

Presentation of case: An 80-year-old man developed a fever 7 days after an atrial fibrillation ablation procedure, using a suture-mediated vascular closure device. Blood cultures revealed the presence of Staphylococcus aureus. Subsequently, a rapidly enlarging mass appeared in the right thigh on the 14th postoperative day.

Discussion: Computed tomography was suggestive of a pseudoaneurysm, and surgical repair was performed. The mass was incised under balloon expansion at the right common femoral artery, and intraoperative findings confirmed the perforation of the femoral artery and adhesion of the infected tissue, necessitating vascular repair and debridement of the infected area. In our institution's experience, the incidence rate of infectious pseudoaneurysms after the use of vascular closure devices is extremely low at 0.04 %.

Conclusion: Although local infections associated with suturing devices are exceedingly rare, prompt intervention is essential when they occur. This report raises awareness of the importance of diagnosing and managing infected pseudoaneurysms, a complication following catheter ablation, as the onset of the condition occurs with a time lag compared to systemic symptoms.

Introduction: Endoscopic resection is suitable for most benign gastric or early stage cancerous polyps. Laparoscopic local resection is performed only for gastric polyps that are difficult to treat with endoscopic resection, such as recurrent or large polyps. However, when polyps are located in difficult regions, such as the gastric cardia and prepyloric antrum, wedge resection may damage the sphincter around the cardia or pylorus, resulting in postoperative deformity or stenosis.

Presentation of case: A 66-year-old gentleman found a 2.5 cm recurrent adenoma at pre-pyloric antrum when he repeated a esophagogastoscopy 1 year after a 2 cm polyp removed by endoscopic mucosal resection (EMR) at the same site. Owing to submucosal fibrosis, neither EMR nor endoscopic submucosal dissection is considered suitable for recurrent adenoma because of the increased risk of perforation. Pyloric stenosis or deformity was expected with traditional laparoscopic wedge resection for such a lesion located at the pre-pyloric antrum. Instead, we successfully performed a transgastric single-incision laparoscopic en bloc resection of the adenoma. Precise dissection was performed during surgery. The patient's postoperative recovery was uneventful. A repeated esophagogasroscopy one year later showed no recurrence.

Discussion: Transgastric single-incision laparoscopic resection for recurrent gastric mucosal lesions after previous endoscopic resection is technically feasible and safe.

Conclusion: This procedure can be an alternative choice for local resection of recurrent benign gastric mucosal lesions, especially for those located in special regions such as the prepyloric antrum or gastric cardia.

Introduction and importance: Malignant duodenocolic fistulas are a rare but serious complication of advanced colorectal cancer. With the growing elderly population and increasing incidence of advanced colorectal cancer, there is a pressing need to explore palliative alternatives to complete resection, especially when a patient's overall health precludes extensive surgery.

Case presentation: This case report presents a palliative approach involving luminal stent placement via gastroscopy in a patient with non-resectable, locally invasive colorectal cancer, resulting in a malignant duodenocolic fistula.

Clinical discussion: We discuss different palliative treatment strategies against malignant duodenocolic fistulas, including endoscopic luminal stent placement and specific technical aspects of this procedure, highlighting factors that may contribute to a successful clinical outcome.

Conclusion: Endoscopic stent placement can represent a minimally invasive palliative strategy to provide symptom relief in a patient with advanced colorectal cancer. Treatment strategy should be considered on a individual basis and in close consultation with the patient.

Introduction and importance: Osteoblastoma is a rare benign bone tumor, accounting for 1 % of primary bone tumors, often affecting the spine and sacrum. Accurate diagnosis is essential for appropriate treatment and prognosis.

Case presentation: A 19-year-old male presented with two years of persistent nocturnal radicular and low back pain unresponsive to anti-inflammatory medications. Physical examination revealed a left-sided gibbosity and a positive Sonnette sign at lumbar levels L3-L4 and L4-L5 without neurological deficits. MRI and CT scans revealed anomalies in the right facet joint at L3-L4 and a lytic lesion at the L3 inferior articular process, suggestive of osteoblastoma. The patient underwent en bloc resection of the right L3 inferior articular process, decompression of the right L3 root, and tumor curettage. A unilateral fixation with pedicle screws was performed to prevent instability. Histological examination confirmed osteoblastoma. The patient's postoperative recovery progressed moderately, and he is actively participating in physical therapy, with continued follow-up planned to monitor for any potential recurrence or complications.

Clinical discussion: Osteoblastoma diagnosis is based on clinical, radiological, and histopathological evaluation. It is important to distinguish osteoblastoma from similar tumors for appropriate management. Surgical intervention, including en bloc resection or curettage, is the treatment of choice based on clinical factors and tumor location.

Conclusions: This case highlights the challenges in diagnosing spinal osteoblastoma, especially in young patients with persistent back pain. Early recognition, prompt intervention, and surveillance are critical for optimal outcomes.

Background: Lentigo maligna (LM) and lentigo maligna melanoma (LMM) are the most prevalent subtypes of melanoma, primarily affecting sun-exposed areas of the face in individuals aged 65 to 80 years. LM accounts for approximately 80 % of in situ melanomas and carries a risk of progression to LMM, which constitutes 4 % to 15 % of global cutaneous melanoma cases. This report discusses the clinical challenges and management strategies for recurrent LM, with an emphasis on accurate diagnosis and surgical intervention.

Case presentation: A 71-year-old female presented with a pigmented lesion on her left cheek that had recurred after excision six years earlier. Histopathological examination confirmed a diagnosis of LMM, revealing atypical melanocytes and solar elastosis. The lesion was surgically excised using the rotation flap technique, resulting in favorable aesthetic outcomes and no recurrence at the six-month follow-up.

Discussion: The paper highlights the slow growth of LM and a 3.5 % annual risk of progression to LMM. Surgical excision remains the preferred treatment, necessitating a minimum margin of 5 mm due to a 20 % local recurrence rate, which is particularly challenging for facial lesions. The limitations of radiotherapy as an adjunctive treatment are acknowledged, given the high recurrence rates associated with this approach.

Conclusion: This research underscores the complexities involved in managing LM and LMM, connecting them to chronic sun exposure and the associated risk of invasive melanoma. It emphasizes the necessity for accurate diagnosis and sufficient surgical excision to minimize recurrence rates. Furthermore, it highlights racial disparities in incidence, advocating for tailored prevention strategies and ongoing research into effective treatment protocols and adjunctive therapies to improve patient outcomes.