International Journal of Surgery Case Reports最新文献

Introduction: Hydatid disease, caused by the larval stage of Echinococcus granulosus, is a significant zoonotic infection predominantly affecting the liver and lungs. While hydatid cysts are commonly found in internal organs, cases in the axillary region are rare.

Presentation of case: We report a unique case of a 52-year-old female patient presenting with a painless left axillary swelling for two years. Physical examination revealed a firm, mobile mass measuring 10 × 5 cm, with no associated lymphadenopathy. Laboratory tests indicated normal results, while ultrasound imaging confirmed a thick-walled cystic lesion. The patient underwent total cystectomy under general anesthesia, and histopathological analysis confirmed the diagnosis of a hydatid cyst.

Discussion: Hydatid cysts typically originate in the liver or lungs, with axillary primary cysts being rarely documented, with less than 20 prior cases in English literature. The mechanism for larvae migration to the axillary region remains unclear. The patient exhibited a mobile, asymptomatic mass, and imaging studies were crucial for diagnosis, emphasizing that differential diagnoses should include various axillary masses such as lymphadenitis or neoplasms.

Conclusion: This case highlights the need for awareness of axillary hydatid cysts in endemic regions, which may be misdiagnosed due to their rarity. Prompt diagnosis and individualized treatment, including total cystectomy and adjunctive medical therapy with albendazole, are critical to prevent complications and recurrence of hydatid disease.

Introduction and importance: Intraosseous anesthesia (IOA), an important technique in dental anesthesia, delivers anesthetic directly into the bone, enhancing patient comfort and minimizing side effects. Despite advantages, several disadvantages are known such as injection discomfort, root damage, mechanical obstructions and needle fractures. This report highlights a rare yet significant complication of focal mandibular osteonecrosis following IOA.

Case presentation: A 35-year-old male was referred with interdental septum necrosis between teeth 46 and 47, four months post-IOA. CBCT scan confirmed the septum sequestration and periapical osteolysis extending into the mandibular canal. The patient underwent sequestrectomy and tooth extraction under local anesthesia, successfully relieving him of pain.

Clinical discussion: Focal osteonecrosis of the jawbone is possibly caused by factors such as frictional heat, improper pressure during perforation, absence of water cooling, and the use of vasoconstrictor-containing anesthetics, impairing blood flow in the low vascularized bone of the interdental septum. Most osteonecrosis cases so far reported are linked to medication, immunocompromised status or irradiation.

Conclusion: Focal mandibular osteonecrosis is a rare complication of intraosseous anesthesia. To our knowledge, this is the first reported case of focal osteonecrosis in the mandible in a healthy patient. There are no previous reports in the literature to show this complication in an otherwise healthy individual.

Introduction: Digital papillary adenocarcinoma (DPAC) is a rare malignant tumour of the sweat glands, usually in the digits. It has a high rate of recurrence and metastasis, yet there's a lack of guidelines for its diagnosis and management. Therefore, this report aims to evaluate procedures that provide the best outcomes, which will help create a consensus for its management.

Case presentation: This case report presents a 47-year old male who had a painless hyperkeratotic patch on his left index finger, with an additional cystic lesion underlying it. This was diagnosed as a hidradenoma, which later changed to DPAC. His finger was amputated through the head of the middle phalanx. A positive sentinel lymph node biopsy led to a left axillary lymph node dissection, which revealed micrometastasis. The patient declined radiotherapy and was on a melanoma follow-up plan. To date there is no evidence of recurrence.

Clinical discussion: Reviewing studies supported the use of immunohistochemical analysis to identify specific markers, especially HPV42. Sentinel lymph node biopsy and radical excision or amputation had the lowest rate of recurrence and thus should be common practice alongside long-term follow-up. Specific follow-up criteria are debated, yet this case may offer a solution by following the melanoma criteria.

Conclusion: Histological and immunohistochemical analysis (including HPV42 detection), SLNB, and radical excision or amputation are optimal for DPAC management. Long-term follow-up, possibly using melanoma criteria, is crucial. Further research is needed to establish definitive guidelines.

Introduction: The presence of foreign or unexpected external objects in the urinary tract, including the urethra, is a rare case. This case is a challenge for patients with schizophrenia. This case report presents when the unusual corpus alienum invades the urethra in schizophrenia patients.

Case presentation: A 54-year-old man was referred to the emergency room with corpus alienum tweezers inside the urethra. The patient had a history of schizophrenia 30 years ago and had not been routinely treated for the past year. From the physical examination, it was found that the tip of the tweezers penetrated out of the penile gland, and the patient could still urinate without bloody fluid. A pelvic X-ray shows tweezers in the urethra. The results of the urethrography showed a corpus alienum with both ends penetrating the penile gland. There is no clear contrast image visible filling the anterior urethra and a contrasting backflow from the urethra to the hole where the end of the corpus alienum comes out. Management of schizophrenia patients, given haloperidol tablets 2.5 mg/12 h and regular check-ups at psychiatric clinics.

Discussion: Treatment is based on two steps: foreign body extraction and psychiatric treatment for mental illness. Patients need routine treatment, and haloperidol is one of the drugs that can be used.

Conclusion: Extraction management of corpus alienum urethra must be carried out immediately to prevent complications. Comprehensive management is needed if there are other diseases, such as schizophrenia, in these patients to prevent recurrence.

Introduction: Iatrogenic injury to the ilioinguinal nerve and its branches during anterior inguinal hernia repair is a cause of chronic inguinal pain in up to 12 % of patients undergoing this operation. The risk of nerve injury is high, given the nerves' relatively small caliber and strictly-confined space through which they pass. In the current report, we describe using a novel fluorescence imaging system developed to detect nerve autofluorescence in a 66-year-old man who presented with a left-sided Type II inguinal hernia and underwent inguinal hernioplasty.

Case presentation: Under general anesthesia, a left inguinal hernioplasty with mesh was performed using the Lichtenstein technique through an anterior approach. During surgery, a Dendrite® Imaging camera (Dendrite® Imaging, Germany) was employed to allow the surgical team to alternate freely between standard operating room (white) light and near-ultraviolet light (NUVL), specifically to enhance visualization of the ilioinguinal nerve and its branches. Under white light, neither the ilioinguinal nerve nor any of its branches were clearly visible. However, under NUVL, all fluoresced brightly and were easily avoided throughout the course of the hernia repair. The operation proceeded with no intraoperative or postoperative complications.

Discussion: In this case, autofluorescence of the ilioinguinal nerve and its branches under NUVL utilizing a novel, hand-held fluorescent camera during hernia repair aided in their visualization and appeared to help prevent nerve injury.

Conclusion: New intraoperative technology that allows nerves to auto-fluoresce intra-operatively under NUVL warrants larger series and comparative trials to evaluate its efficacy at reducing iatrogenic nerve injury during inguinal hernioplasties.

Background: Sinonasal mucosal melanoma (SNMM) is a rare and aggressive malignancy associated a poor prognosis, prognosis. It is by delayed presentation and nonspecific symptoms. The incidence of SNMM is low, with and there are challenges in achieving local control and managing distant metastases.

Case presentation: We report present case of an 86-year-old female patient with a history of systemic hypertension who presented exhibited symptoms, including blurred vision, rhinorrhea, and facial pain, following initial treatment for SNMM. sinonasal mucosal melanoma (SNMM). studies revealed a heterogeneous lesion in the right nasal cavity and ethmoidal air cells, exhibiting characterized by destruction and invasion into the orbit. The patient underwent functional endoscopic sinus surgery (FESS) for resection, with and analysis confirming confirmed the diagnosis of melanoma.

Discussion: This case underscores the aggressive nature of SNMM and emphasizes importance of early diagnosis and intervention. Despite Although treatment with surgery and radiotherapy leading resulted in resolution for two years, the recurrence of symptoms highlights the challenges in associated with long-term control. The Effective of SNMM requires necessitates multidisciplinary approach, approach that includes resection and the of adjuvant therapies.

Conclusion: SNMM poses presents treatment challenges due to its aggressive behavior nature complex anatomical location. A comprehensive approach involving that includes radiotherapy, and potential systemic therapies is essential for improving enhancing outcomes. Further research is needed necessary explore investigate treatment strategies for this rare malignancy.

Introduction and importance: Stricture formation is a well-known Crohn's disease consequence that usually results from recurrent cycles of inflammation and healing and primarily affects the small intestine.

Case presentation: In this report, we describe the case of a 35-year-old male with an 18-year history of Crohn's disease complicated by long-kinked ileal stricture who presented with a 3-month history of subacute small intestinal obstruction diagnosed with MR enterography and underwent failed medical treatment.

Clinical discussion: The patient, a male showing signs of wasting due to a prolonged subacute small intestinal obstruction, underwent an MR enterography which revealed a 6-cm kinked ileal stricture. Intraoperative observations included a significantly dilated small intestine proximal to the stricture and a collapsed distal small bowel. Following resection, the patient experienced a smooth recovery with marked improvement.

Conclusion: When there are clear indications for the surgical resection of a stenosed bowel segment caused by Crohn's disease, it is advisable to proceed with the surgery promptly, with a preference for side-to-side stapled anastomosis.

Introduction: Appendiceal diverticulitis is an uncommon pathology that imitates acute appendicitis and is usually treated by appendicectomy.

Cases presentation: We present two cases: a 50-year-old female patient and a 35-year-old male patient, both of whom presented with signs and symptoms of acute appendicitis and were managed accordingly. Final pathological examination confirmed the presence of an appendiceal diverticulum.

Clinical discussion: Diverticulitis of the appendix is four times more likely to lead to perforation when compared to appendicitis and may be associated with underlying neoplasm. Therefore, it is extremely important to distinguish diverticulitis of the appendix from appendicitis.

Conclusion: Clinicians should always consider appendiceal diverticulitis when evaluating patients with right-sided, lower quadrant abdominal pain.

Introduction: We present a unique case of acute aortic occlusion secondary to infective endocarditis (IE).

Presentation of case: An Aboriginal Australian woman with systemic lupus erythematosus presented with fever, confusion, tachycardia, and tachypnoea and had cold, pulseless, insensate, and paralysed lower limbs. Computed tomography angiography revealed multifocal occlusion of the distal aorta and lower limb vessels. Broad-spectrum antibiotic therapy was initiated alongside heparin infusion, and thrombectomy and four-compartment fasciotomy of the lower limbs were performed. IE, thrombotic thrombocytopenic purpura, and antiphospholipid syndrome were considered. IE was confirmed by the presence of methicillin-susceptible Staphylococcus aureus in blood cultures and new valvular echogenic lesions on echocardiography. Magnetic resonance imaging revealed diffused T9-T11 spinal cord infarcts. She received a prolonged course of intravenous antibiotics and intensive care and was hospitalised for 9 months. Thereafter, the patient was able to transfer and ambulate independently on flat surfaces and was discharged.

Discussion: IE is associated with significant mortality and morbidity. It is commonly caused by S. aureus. Embolic events occur in 80 % of patients. Acute aortic occlusion secondary to IE has rarely been reported in the literature, and this is the first reported case involving the bilateral lower limbs.

Conclusion: Patients may develop severe infections owing to immunosuppression. Septic emboli can occlude major arteries and cause acute limb ischaemia. A good understanding of the pathophysiology and aetiology of systemic thrombosis will lead to a thorough and broad consideration of differential diagnoses, especially for patients with complex comorbidities and a history of rheumatological disease and immunosuppression.

Background: Adenoid cystic carcinoma (ACC) is a rare malignant tumor that accounts for <1 % of head and neck malignancies, with an estimated involvement of the tongue at approximately 3 %.

Case presentation: This report presents a case of a 42-year-old male with no significant history of tobacco or alcohol use, who developed a painless, progressively enlarging mass on the ventral surface of his tongue over the course of eight months. Initial surgical resection confirmed the diagnosis of ACC, which necessitated a right hemiglossectomy followed by radiotherapy to address potential residual disease.

Discussion: ACC of the tongue presents unique clinical challenges due to its rarity and aggressive nature. The lack of traditional risk factors indicates that ACC can arise in low-risk populations, underscoring the necessity for heightened awareness among healthcare professionals to facilitate early detection. Surgical resection remains the standard treatment; however, achieving negative margins is challenging due to the tumor's infiltrative characteristics, which can lead to local recurrence. Histologically, ACC is classified as a biphasic neoplasm often associated with perineural invasion, and high-grade transformation increases the risk of metastasis. Postoperative radiotherapy is recommended to reduce the risk of recurrence, particularly in cases exhibiting unfavorable histological features. A personalized treatment strategy that takes into account tumor characteristics and patient-specific factors is essential for effective management.

Conclusion: This case underscores the importance of vigilance in identifying symptoms of ACC of the tongue, even in low-risk individuals. It advocates for a multidisciplinary approach that includes surgical intervention and adjuvant radiotherapy to achieve optimal outcomes.