International Journal of Surgery Case Reports最新文献

Introduction: Bladder injuries that occur during laparoscopic surgery are rare but a serious complication. In particular, patients with urachal remnants have a high risk for bladder injuries during suprapubic port insertion. We report the case of a bladder injury caused by a urachal remnant during laparoscopic ileocecal resection for cecal cancer.

Case presentation: A 46-year-old man diagnosed with cT2, N0, M0, stage I cecal cancer underwent laparoscopic ileocecal resection. A suprapubic port was inserted under direct vision. After ileocecal resection, a bladder injury was discovered after the removal of the suprapubic port. The suprapubic port wound was extended to reveal the bladder wall around the injury, and the injury was sutured. During surgery, preoperative computed tomography (CT) results were reviewed, and sagittal CT revealed a urachal remnant. The postoperative course was uneventful, and the patient was discharged 10 days after surgery.

Discussion: Urachal remnants are rare in adults. This case emphasizes that although it is difficult to diagnose asymptomatic urachal remnants preoperatively, sagittal CT scans may aid in the diagnosis. Careful consideration of port placement and preoperative urethral catheter insertion is important to prevent bladder injuries in cases of urachal remnants.

Conclusion: Sagittal CT scans are considered effective in detecting diverticulum-type urachal remnants. Port placement without the need for a suprapubic trocar should be considered in cases with urachal remnants.

Introduction and importance: Mesenteric cysts are a rare group of intra-abdominal tumors located in the mesentery or omentum, most of this lesion are asymptomatically but occasionally presents with non-specific symptoms, which makes diagnosis difficult.

Case presentation: We present two cases of giant mesenteric cyst in our Institution, the first case is a women of 23 years with previous gynecologic surgery with chronic abdominal pain and large abdominal mass CT showed a giant intraabdominal 30 × 25 × 15 cm, the patient went to laparotomy and a large mesenteric tumor found. The Histopathology reported a Benign cyst mesothelioma (BCM). The second case is a 47 year male with intermittent abdominal pain and abdominal CT shows a 20x21x15 cm tumor. Laparotomy was performed. Histopathology reported a large lymphangioma.

Clinical discussion: BCM tumors are rare intrabdominal lesions often diagnosed in premenopausal women. Its etiopathogenesis is still unclear, associated risk factors are endometriosis, pelvic inflammatory disease and previous pelvic surgery. Lymphangiomas are an infrequent cyst tumors. It results from a failure in the evolutionary development of the lymphatic system, often localized in the head and neck and its localization in the abdomen is even rare. The definitive diagnosis is made by histopathology.

Conclusion: Mesenteric cysts diagnosis if often challenge due to nonspecific symptoms and significant overlap in imaging appearance between the different entities, its diagnosis should be in mind when encounter a cystic abdominal tumor, surgical complete removal of this tumors is the optimal treatment to prevent recurrence and complications.

Introduction and importance: Rosai-Dorfman disease (RDD) is a rare benign histiocytic proliferative disorder characterized by painless lymph node enlargement and extranodal involvement. This disease often presents diagnostic challenges due to its variable clinical manifestations and the need for histologic confirmation.

Case series presentation: This case series examines five patients diagnosed with Rosai-Dorfman disease who presented with a variety of clinical manifestations. Patients ranged in age from 21 to 72 years and presented with a variety of symptoms including cervical lymphadenopathy, mediastinal adenopathies, thyroid nodules, and nasal obstruction. Diagnoses were confirmed by histologic examination and immunostaining, primarily with anti-PS100 antibody. Treatments included surgery, corticosteroids, and laser resection, with most cases showing favorable outcomes and no recurrence at follow-ups ranging from one to five years.

Clinical discussion: The diverse presentations of RDD in this case series underscore the importance of considering this entity in the differential diagnosis of lymphadenopathy and other mass lesions. Histologic examination and immunostaining are critical for accurate diagnosis.

Conclusion: This case series aims to highlight the diverse presentations, diagnostic approaches, and treatment outcomes of patients with Rosai-Dorfman disease and to contribute to a better understanding of this rare condition.

Introduction and importance: Intestinal intussusception is rare in adults and often associated with underlying malignancies. In this case, a colo-colic intussusception involving the descending colon caused acute obstruction, ischemic pain, and carried a high risk for peritonitis, necessitating urgent surgical intervention to prevent severe complications.

Case presentation: We report the case of a 50-year-old male who presented with acute abdominal obtruction and a three-day history of fecal vomiting, left-sided abdominal pain, and recent rectal bleeding. Imaging revealed colo-colic intussusception of the descending colon due to a colonic tumor. Immediate surgical intervention was performed with an oncologic resection of the invaginated segment, including a left hemicolectomy with lymph node dissection. A diversionary left iliac colostomy was conducted, ensuring clear resection margins and reducing the risk of postoperative complications.

Clinical discussion: Intussusception in adults, while rare, frequently indicates a malignant etiology, and prompt diagnosis and management are essential. In this case, rapid surgical intervention allowed successful removal of the tumor with favorable oncologic outcomes and no recurrence at two-year follow-up. This case highlights the complexity of diagnosing intussusception in adults, where symptoms may mimic other gastrointestinal conditions and are often nonspecific.

Conclusion: This case underscores the critical importance of early detection and intervention for intussusception in adults. Awareness among physicians should be heightened to consider intussusception in adult patients presenting with symptoms such as ischemic pain or a palpable mass with associated pain, as timely intervention can lead to improved outcomes and reduce morbidity.