International Journal of Surgery Case Reports最新文献

Introduction and significance: Lymphangiomas are benign vascular malformations commonly found in the head and neck region, although they can occur elsewhere. Clinical manifestations vary based on location and size. Surgical resection remains the primary treatment modality.

Case presentation: A male child presented with progressive abdominal distension without associated symptoms. Emergency department evaluation revealed a palpable abdominal mass. Abdominal ultrasound and computed tomography (CT) scans confirmed a large abdominal cyst. The cyst was surgically removed, and pathological examination diagnosed mesenteric lymphangioma.

Clinical discussion: Despite their infrequent occurrence, mesenteric cysts should be included in the differential diagnosis of pediatric abdominal masses.

Conclusion: Complete surgical resection is essential for the definitive management of mesenteric lymphangioma. Partial resection or aspiration should be avoided due to the risk of complications and potential recurrence.

Introduction and importance: Biliary ileus is a rare yet significant cause of mechanical intestinal obstruction, which occurs when a gallstone enters the gastrointestinal tract through a bilioenteric fistula, leading to intestinal blockage. This condition primarily affects elderly patients and is associated with high morbidity and mortality if not diagnosed and treated promptly.

Case presentation: We present the case of a 94-year-old female with a history of hypertension and chronic venous insufficiency. The patient was admitted with severe abdominal pain, nausea, and vomiting, with clinical findings suggestive of intestinal obstruction. Computed tomography revealed Rigler's triad, confirming the diagnosis of biliary ileus. An exploratory laparotomy was performed, identifying three gallstones in the small intestine. The patient underwent enterotomy for stone extraction and had a favorable immediate postoperative outcome.

Clinical discussion: Biliary ileus presents a diagnostic challenge due to its nonspecific symptoms. While Rigler's triad (pneumobilia, intestinal obstruction, and ectopic gallstone) is diagnostic, it is not always apparent in imaging. Surgical intervention remains the standard of care for resolving the obstruction, though appropriate preoperative management and timely surgery are crucial for improving outcomes.

Conclusion: This case emphasizes the importance of considering biliary ileus in the differential diagnosis of intestinal obstruction, particularly in elderly patients. Early surgical intervention is essential to prevent severe complications. Evidence based medicine ranking: Level IV.

Introduction: Schwannomas are encapsulated nerve sheath tumors derived from Schwann cells, primarily found in the head, neck, and extremities. Retroperitoneal schwannomas are rare and typically asymptomatic.

Case presentation: A 36-year-old female presented with a long-standing, asymptomatic right lower abdominal mass. Imaging revealed a retroperitoneal cystic mass displacing adjacent structures. The tumor was surgically excised, and histopathology confirmed the diagnosis of schwannoma. The patient had an uneventful postoperative recovery and remains symptom-free with no signs of recurrence.

Discussion: Schwannomas are benign nerve tumors primarily affecting women aged 30 to 50. This case involved an asymptomatic retroperitoneal schwannoma displacing the inferior vena cava without neurological symptoms. Imaging methods like ultrasound and CT are useful but often lack definitive results, and preoperative biopsy is not recommended due to risks of vascular injury. While conservative management may be suitable for asymptomatic cases, complete surgical excision is crucial to prevent recurrence. Although some suggest partial excision, most literature supports curative resection with negative margins, as incomplete removal can lead to a 10-20 % recurrence rate. The patient underwent successful complete resection.

Conclusion: Retroperitoneal schwannomas are rare tumors that are difficult to diagnose preoperatively. Radiologic findings are usually nondiagnostic. The treatment of choice is complete surgical excision.

Introduction and importance: In elderly patients with atherosclerotic disease the occlusion of splanchnic arteries is a frequently observed variation, which doesn't normally affect patient's condition. There are sporadic reports on pancreatoduodenectomy in these cases.

Case presentation: A 72-year-old female was admitted to our department with cancer of the ampulla of Vater. Pre-operative CT-angiography revealed total atherosclerotic occlusion of the main trunk of the superior mesenteric artery (SMA). Collateral circulation was conducted through gastroduodenal and dorsal pancreatic artery. Pancreatoduodenectomy was performed with an intraoperative clamping test, which showed no signs of bowel ischemia. The patient was discharged on post-operative day 14 without any complications, and long-term follow-up revealed adjustment of collateral circulation through the inferior mesenteric artery and Riolan's arcade.

Clinical discussion: Most cases of mesenteric artery stenosis occur in patients with underlying cardiac condition. As the occlusion develops chronically, it doesn't cause any symptoms due to collateral circulation, and no preoperative intervention is usually needed. However, there are rare cases reported in the literature, when preoperative endovascular stenting and SMA dilation were performed before pancreatoduodenectomy. In this report we decided to proceed with surgery upfront and perform an intraoperative clamping test.

Conclusion: In this report we present a rare case of successful pancreatoduodenectomy in a patient with total atherosclerosis of the superior mesenteric artery. The intraoperative clamping test allowed us to assess both the sufficiency of collateral circulation and the feasibility of the surgery.

Introduction and importance: Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure used to treat severe aortic stenosis. While TAVI is generally safe and effective, it can be complicated by rare adverse events such as prosthetic leaflet dislodgment leading to acute free aortic regurgitation.

Case presentation: We report the case of a female patient who experienced acute free aortic regurgitation following elective TAVI. This complication arose due to prosthetic leaflet dislodgment after post-dilatation of the implanted valve. The timely identification and management of this rare complication are essential to prevent potentially fatal outcomes.

Clinical discussion: The moderate paravalvular regurgitation (PVR) observed in this case was likely caused by the unsealing of heavily calcified aortic valve leaflets. While post-dilatation is a routine practice to optimize valve function, it poses the risk of serious complications, including leaflet dislodgment. Transoesophageal echocardiography (TEE) confirmed the loss of function of the prosthetic leaflet, which was likely exacerbated by aggressive post-dilatation techniques. The use of intravascular lithotripsy could be considered to mitigate the risk of significant PVR by effectively modifying the calcified valve structure.

Conclusions: Acute prosthetic leaflet dislodgment leading to free aortic regurgitation is a very rare but serious complication of TAVI. Early recognition and immediate intervention are crucial to manage this life-threatening event and optimize patient outcomes.

Introduction and importance: Cholecystectomy is the most common general surgery procedure, necessitating thorough knowledge of bile duct anatomy. Despite the bile duct's anatomical diversity, reports of double cystic ducts are rare. This case presentation aims to emphasize the importance of recognizing this unusual anatomical variant during surgical procedures to prevent complications and ensure patient safety.

Case presentation: This is a 22-year-old woman with a history of lupus. Initial clinical and ultrasound evaluations concluded she had cholangitis, choledocholithiasis, and cholecystitis. A cholecystectomy was performed, during which a double cystic duct was identified and confirmed with intraoperative cholangiography. Five days after surgery, the patient exhibited increased bilirubin levels, and a follow-up cholangiography showed dilation of the common bile duct with no passage of contrast medium into the duodenum. She underwent ERCP with endoprosthesis placement and is currently under follow-up with adequate progress.

Clinical discussion: Double cystic ducts are extremely rare anatomical variants. These variations pose significant challenges for surgeons during surgery, emphasizing the need for a universal culture of safety during cholecystectomy. Although this anatomical variant is rare, surgeons must be aware of it. Given the uncertainty of anatomy, it is advisable to perform intraoperative imaging, such as cholangiography, before sectioning any duct.

Conclusion: Double cystic duct variations are rare, but when bile duct anatomy is unclear, intraoperative cholangiography is essential. This technique improves visualization of biliary structures, aiding informed decisions before duct ligation and reducing the risk of bile duct disruption.

Introduction and importance: Emphysematous cystitis is a rare and serious urinary tract infection with gas in the bladder, commonly affecting elderly diabetic women. Prompt evaluation and management are vital due to its potential life-threatening nature, associated with risk factors like diabetes, neurogenic bladders, and urinary stasis.

Case presentation: A 55-year-old woman with type 1 diabetes presented confusion, lumbar pain, and urinary symptoms. Elevated CRP, white blood cells and imaging revealed extensive emphysema. Urinary drainage and empirical antibiotics (Ceftriaxone, metronidazole, amikacin) targeting Klebsiella pneumoniae led to clinical improvement. A 14-day treatment was followed by referral to an endocrinologist for diabetes management.

Discussion: Emphysematous cystitis, often linked to poorly controlled diabetes, presents diverse symptoms. Diagnosis relies on imaging, with computed tomography being the gold standard. Symptoms range from asymptomatic to severe, necessitating prompt intervention and tailored antibiotic therapy. Successful treatment involves addressing risk factors, emphasizing glycemic control.

Conclusion: Emphysematous cystitis demands prompt attention, considering its rarity and potential severity. Timely diagnosis and comprehensive management are crucial for a favorable prognosis, highlighting the need for swift physician intervention.

Introduction: Colorectal Carcinoma (CRC) has recently been on the rise among children, bearing a prevalence of 1-2 children/adolescents per million people. Here, we present a rare case of CRC in a 14-year-old male, emphasizing the need for development of better screening techniques to diagnose CRC earlier and with adequate time for intervention.

Case presentation: A 14-year-old male visited our hospital with constipation, intermittent per rectal bleed and dull-aching pain abdomen for 2 months. On per rectal examination, a hard mass was identified, approximately 3 cm above the anal verge. Contrast-enhanced CT (Chest and Abdomen) and MRI Pelvis identified a circumferential thickening in the rectum predominantly involving the anterior rectal wall with effacement of fat planes with the Urinary Bladder without infiltrating it. Colonoscopic biopsy identified Signet Ring Adenocarcinoma. A multi-disciplinary decision was taken to treat him with neoadjuvant chemotherapy and radiotherapy (NACT-RT). MRI Pelvis, post-NACT-RT, showed that the previously- effaced fat plane was now clear and an Abdominoperineal Resection (APR) with permanent end- descending-colostomy was done. Histopathology report of the specimen identified a poorly undifferentiated mucin-secreting adenocarcinoma.

Discussion: At presentation, the patient could have been either planned for extensive surgery or NACT-RT. The choice of NACT-RT was justified in our patient and was advantageous as extensive surgery was prevented.

Conclusion: We implore vigilance in cases of rectal masses due to the rising incidence of CRC among children. We also advocate that there must be no hesitation in subjecting adolescents to Chemotherapy and/or radiotherapy, as the benefits significantly outweigh the risks of with-holding.

Introduction: Giant cells tumor (GCT) of the bone is usually seen in young adults between the ages of 20 and 40. When occurring in older patients, diagnosis and therapeutic specific feature are to be considered. We underline those aspects through this case report.

Case presentation: We report the case of a 73-year-old man presenting with a painful swelling knee. The diagnosis of GCT of proximal tibia was retained and the patient underwent extensive curettage, subchondral bone grafting and cementation of the residual cavity. The long-term results show a good functional outcome and no recurrence.

Discussion: In this age group, other lesions have similar clinical and radiological presentations as GCT of bone. The diagnosis of a metastatic carcinoma is to be carefully ruled-out in this situation. While the option of large resection with joint arthroplasty is better accepted in ageing patients as a treatment of GCT of bone, this case suggests that jointpreserving methods should also be considered especially when there are no signs of osteoarthritis. While polymethylmethacrylate cementation is an efficient adjuvant in order to reduce recurrences, it may cause secondary osteoarthritis. Subchondral grafting seems to be a good alternative to prevent this complication.

Conclusion: Malignancies should be ruled-out before retaining the diagnosis of GCT of the bone after the age of 50. Conservative surgical treatment is always an option in this age group.

Introduction: This report details a case of Type I oblique vaginal septum syndrome (OVSS), highlighting its complexity as a congenital uterine malformation.

Case presentation: A 12-year-old girl presented with severe lower abdominal pain coinciding with her first menstrual period. Ultrasound revealed a septate uterus and an oblique vaginal septum, prompting an emergency hysteroscopic procedure that confirmed the diagnosis of Type I OVSS.

Discussion: OVSS is a rare urogenital anomaly often diagnosed during adolescence. Common symptoms include abdominal pain, abdominal masses, and irregular vaginal bleeding. Due to its atypical presentation, OVSS is frequently misdiagnosed. Early surgical intervention is crucial to relieve pain and restore normal uterine morphology.

Conclusion: Diagnosing OVSS can be challenging, but early detection is vital to prevent complications such as retrograde menstruation and long-term issues.