International Journal of Surgery Case Reports最新文献

Introduction and importance: Intussusception is a common pediatric condition characterized by the invagination of a proximal bowel segment into a distal segment, leading to intestinal obstruction and acute abdominal symptoms. While most cases are idiopathic, rare secondary causes, such as gastrointestinal Burkitt lymphoma, can occur.

Presentation of case: A 5-year-old Ethiopian male presented in January 2024 with a 24-h history of crampy abdominal pain, vomiting, abdominal distension, and currant jelly stool. Examination revealed fever (38 °C), tachypnea (28 breaths/min), tachycardia (125 bpm), and abdominal tenderness. Ultrasound showed a target sign, and after resuscitation, the patient underwent surgery for suspected intussusception. Intraoperatively, ileocecal intussusception with an intraluminal mass serving as the lead point was identified and resected with primary anastomosis. Histopathology confirmed Burkitt lymphoma. Postoperative follow-up was uneventful.

Clinical discussion: Burkitt lymphoma is a highly aggressive B-cell non-Hodgkin lymphoma that rarely presents as a lead point for ileocecal intussusception in children. While factors like immunocompromise and Epstein-Barr virus (EBV) are often implicated, sporadic cases, such as the one presented here, can occur without identifiable risk factors. Diagnosis typically relies on postoperative histopathology, and complete surgical resection is associated with excellent outcomes.

Conclusion: Burkitt lymphoma is an aggressive B-cell non-Hodgkin lymphoma that can rarely cause secondary intussusception. Accurate postoperative evaluation and histopathological diagnosis, along with complete surgical removal followed by chemotherapy, are essential for a favorable outcome.

Introduction and importance: Spontaneous celiac trunk dissection (SCTD) is a rare (0.08 % of arterial dissections) but potentially life-threatening vascular emergency. It is often underdiagnosed due to its subtle presentation and uncommon nature. While hypertension and connective tissue disorders are known risk factors, the vascular toxicity of chemotherapy is an emerging concern.

Case presentation: We report a case of SCTD in a 59-year-old male with metastatic colon cancer, who developed symptoms during treatment with FOLFIRI and cetuximab. Despite well-controlled hypertension and no significant vascular history, the dissection occurred shortly after chemotherapy administration, Imaging confirmed diagnosis without ischemia.

Clinical discussion: The close temporal relationship between chemotherapy and symptom onset raises the possibility of chemotherapy-induced endothelial injury as a contributing factor. Imaging confirmed the diagnosis, and the patient was successfully managed conservatively without surgical or endovascular intervention.

Conclusion: This case suggests FOLFIRI/cetuximab may trigger SCTD, emphasizing the need for vascular awareness in cancer patients with atypical abdominal pain.

Introduction: Multilocular cystic nephroma (MLCN) is a rare benign renal tumor of uncertain etiology that affects primarily infants and young children. Clinically and radiologically, it can closely resemble malignant renal tumors such as cystic partially differentiated nephroblastoma (CPDN) and cystic Wilms tumors, which makes a precise preoperative diagnosis particularly challenging.

Case presentation: We report the case of a 15-month-old male infant who presented nonspecific symptoms, including diarrhea, reduced appetite, and progressive abdominal distension. Physical examination revealed a failure to thrive and a well-defined and firm abdominal mass. Imaging studies demonstrated a multilocular cystic lesion in the left kidney without evidence of calcification, lymphadenopathy, or metastasis. Due to diagnostic ambiguity and the suspicion of malignancy, an open radical nephroureterectomy was performed. Gross pathology revealed a multiloculated mass filled with clear fluid, and histological evaluation confirmed the diagnosis of MLCN.

Clinical discussion: This case underscores the difficulty in distinguishing MLCN from malignant cystic renal tumors based solely on imaging. Although MLCN is benign, the potential for misdiagnosis requires surgical intervention. Complete excision remains both diagnostic and curative. Long-term outcomes are excellent, with a low risk of recurrence or malignant transformation. In our case, the child recovered well after the operation and showed no evidence of recurrence after ten years of follow-up, highlighting the favorable prognosis with appropriate treatment.

Conclusion: MLCN should be considered in the differential diagnosis of pediatric cystic renal masses. Despite its benign behavior, surgical resection is often required due to diagnostic uncertainty. This case illustrates the importance of a multidisciplinary approach in the evaluation of renal tumors in children and reinforces the need for long-term follow-up.

Introduction: The vitellointestinal duct is an embryological remnant of the vitelline duct, which normally obliterates in the 5th to 9th week of gestation. Failure to obliterate the vitellointestinal duct may lead to diverse types of congenital intestinal malformations, including a patent vitellointestinal duct.

Case presentation: A 4-day-old female neonate presented to our hospital with a big protruding mass around the belly button. At presentation, she was acutely sick-looking in cardiorespiratory distress, cyanotic, grossly preterm, and had gross dysmorphic features. There was an umbilical area defect with herniated bowel covered with a sac with prolapsed bowel tissue with exposed mucosa having a T-shaped appearance. After a primary stabilization, the child underwent surgery, and we found a patent omphalomesenteric duct at the distal ileum, with the ileum prolapsing through it. After reducing the prolapse, the patent omphalomesenteric duct was wedge resected, and the ileum was anastomosed. She deteriorated further in the early post-operative days from decompensated heart failure due to the complex cyanotic congenital heart disease and died on the second postoperative day.

Discussion: The omphalomesenteric duct, also known as the vitelline duct, is an embryological structure that provides nutritional support to the developing fetus during early gestation. Under normal circumstances, it undergoes complete obliteration between the 5th and 7th weeks of gestation. However, in rare cases, it may persist and give rise to various complications, such as the passage of meconium through the umbilicus. In infrequent instances, as seen in our patient, the bowel may prolapse through a patent omphalomesenteric duct.

Conclusion: Patent vitellointestinal duct is a rare anomaly that can be complicated by bowel prolapse through it, an emergency that needs urgent surgical correction.

Introduction and importance: Aggressive angiomyxoma is a rare, slow-growing mesenchymal tumor typically found in the vulvo-perineal and pelvic region of women of reproductive age. Its benign but locally invasive nature and high recurrence rate make accurate diagnosis and management challenging. This case highlights a common diagnostic pitfall and underscores the importance of imaging and histopathological confirmation.

Presentation of case: A 32-year-old woman presented to the emergency department with a painful vulvar mass initially diagnosed as bartholinitis. Magnetic resonance imaging (MRI) revealed a well-limited mass in the left labia majora extending to the clitoris. Initial surgical excision resulted in an R2 margin, confirmed by histopathology to be aggressive angiomyxoma. The patient underwent a mandatory surgical revision, achieving R0 excision. The postoperative course was uneventful, with a good outcome at the six-month follow-up.

Clinical discussion: This case illustrates the propensity for aggressive angiomyxoma to be misdiagnosed as more common conditions like Bartholin's gland cysts. MRI is the imaging modality of choice for characterizing the lesion and planning surgery. Complete surgical excision (R0) is the cornerstone of treatment to minimize the high risk of local recurrence. Hormonal therapy with GnRH analogues can be considered as an adjuvant treatment.

Conclusion: Aggressive angiomyxoma is a rare pathology that requires a high index of suspicion. Management should be undertaken in specialized centers with expertise in soft tissue tumors to ensure complete resection and manage potential recurrences. Increased awareness among clinicians is crucial for early diagnosis and appropriate treatment.

Introduction: The ileocolic vein (ICV) is an important anatomical landmark during surgery for right colon cancer. However, surgeons sometimes encounter anatomical variations in the vascular anatomy. Robot-assisted surgery, featuring articulated instruments and advanced three-dimensional visualization, offers significant advantages in managing complex vascular variations. This is the first documented instance of a preoperatively diagnosed ICV anomaly that was successfully treated using robot-assisted laparoscopy.

Presentation of case: A 68-year-old woman with a medical history of bronchial asthma and allergy to contrast media presented with right lower abdominal pain. Further evaluation revealed the presence of ascending colon cancer. Noncontrast abdominal computed tomography showed that the roots of the ileocolic vein and artery were anatomically separated. The ICV joined the accessory right colic vein (ARCV) and drained into the gastrocolic trunk of the Henle. The right colic artery coursed ventrally toward the trunk and ran parallel to the ARCV. The patient underwent robotic-assisted laparoscopic right hemicolectomy with D3 lymph node dissection.

Discussion: In rare cases where the ICV drains into the GCT, recognizing vascular anatomy preoperatively is crucial. While conventional laparoscopy is feasible, robot-assisted surgery enhances safety and precision through improved articulation and dexterity, making it advantageous in anatomically complex situations.

Conclusion: We performed robot-assisted laparoscopic right hemicolectomy for ascending colon cancer with anatomical variations in the ICV draining directly into the gastrocolic trunk. The robot-assisted approach enabled safe and precise dissection despite the vascular anomaly owing to its articulated instruments and enhanced visualization.

Introduction and importance: Spontaneous and massive gingival bleeding is a rare clinical symptom that can lead to severe morbidity, particularly when associated with systemic diseases such as hemophilia. Aneurysmal bone cyst (ABC) is a vascular lesion capable of causing massive gingival bleeding.

Case presentation: A 2-year-old male presented with a gradually enlarging lump on the left cheek over 5 months, accompanied by recurrent bleeding. The patient had a history of hemophilia B and prior treatment.

Clinical discussion: Massive recurrent gingival bleeding associated with ABC and hemophilia represents a clinical challenge. Management must focus on preventing complications from severe blood loss. Selective embolization provides an effective therapeutic option in such cases.

Conclusion: Selective embolization is a minimally invasive and effective treatment for preventing severe complications in patients with ABC and hemophilia, offering a valuable alternative to invasive surgical intervention.

Introduction: Hydatid disease, caused by the Echinococcus tapeworm, can form cysts in various parts of the body, mostly in the liver and lungs. These cysts may remain asymptomatic in the lungs or, upon rupture, can lead to pneumothorax and empyema.

Case presentation: We present a case of a 22-year-old male presented with sudden onset of chest pain and dyspnea. After being referred to our hospital and based on physical examination and CT scan findings, he was diagnosed with spontaneous rupture of a pulmonary hydatid cyst. During thoracotomy, massive amounts of empyema and necrotic tissues were discovered in the pleural cavity which were surgically removed. The patient had unremarkable recovery; as his respiratory symptoms were totally resolved, he was discharged within a week with a chest tube inserted.

Discussion: Despite being rare, hydatid disease should be considered as a differential diagnosis for pneumothorax, pleural effusion and empyema in the pleural cavity, particularly in endemic regions. Non-complicated cysts, could be discovered by chest X ray, However, for complicated cysts, CT scan is the choice for diagnosis.

Conclusion: In endemic regions, hydatid cysts should be considered an important differential diagnosis for nonspecific respiratory symptoms, and a surgical approach should be considered for excising the cyst remnants.