International Journal of Surgery Case Reports最新文献

Introduction and importance: Congenital urethral stenosis (CUS) in female infants is an exceptionally rare urological anomaly. When combined with vesicoureteral reflux (VUR) and a solitary functional kidney, it presents a significant risk for renal deterioration. Early recognition is essential to avoid irreversible damage, especially in complex cases with multiple comorbidities.

Case presentation: We report the case of a 33-month-old female born prematurely at 26 weeks, with a history of omphalocele repair, ventriculitis, retinopathy of prematurity, and a chromosomal abnormality. She presented with recurrent febrile urinary tract infections and worsening hydronephrosis of her only functional kidney. Multiple catheterization attempts failed due to a pinhole-sized urethral meatus. Examination under anesthesia revealed congenital urethral stenosis, which was managed with serial dilations allowing catheter placement and voiding cystourethrogram (VCUG). Imaging showed a trabeculated bladder with diverticula, grade V VUR, and laterally displaced ureteral orifice. Due to persistent infections and poor compliance with catheterization, a vesicostomy was performed. The patient subsequently remained infection-free, with improved renal function and resolution of hydronephrosis.

Clinical discussion: This case highlights the diagnostic challenge posed by CUS in females, particularly in the context of solitary kidney and developmental delay. The absence of obvious obstructive symptoms may delay diagnosis. In such complex scenarios, vesicostomy provides effective bladder drainage, protects upper tract function, and simplifies care when clean intermittent catheterization is not feasible.

Conclusion: CUS should be included in the differential diagnosis of bladder outlet obstruction in female infants, particularly those with recurrent UTIs and solitary kidney. In carefully selected patients, vesicostomy remains a valuable interim or long-term solution to preserve renal function and improve quality of life.

Introduction and importance: Delayed presentation and advanced-stage diagnosis of soft-tissue malignancies such as rhabdomyosarcoma remain major challenges in low-resource settings, often resulting in poor outcomes and complex management needs.

Case presentation: We report the case of a 19-year-old Tanzanian male with advanced rhabdomyosarcoma of the right upper limb. Limited health literacy, cultural beliefs, and economic constraints delayed his initial presentation. Despite early care at a regional facility, poor referral processes and inability to afford imaging led to a one-year delay in definitive treatment. He ultimately presented with a large, ulcerated, maggot-infested tumor requiring shoulder disarticulation and forequarter amputation. Recurrent wound infections necessitated prolonged antibiotic use, raising concerns about antimicrobial resistance.

Clinical discussion: This case highlights multifactorial barriers to timely cancer care, including sociocultural factors, financial limitations, and weak referral systems. The advanced presentation necessitated radical surgery, which could have been avoided with early detection. The case underscores the importance of cancer awareness programs, improved referral pathways, and antimicrobial stewardship in chronic cancer care.

Conclusion: This case emphasizes the urgent need for community-based cancer awareness, streamlined referral pathways, and affordable diagnostic strategies in low-resource settings. Improving early detection, strengthening health education, and integrating antimicrobial stewardship can reduce delays, improve outcomes, and alleviate healthcare burdens for patients with advanced malignancies.

Introduction and importance: Penile strangulation is a rare urological emergency first described in 1755, often resulting from foreign object entrapment leading to vascular compromise, oedema, and potentially necrosis or gangrene. It is associated with delayed presentation due to patient embarrassment and lacks standardized management protocols. This report emphasizes the clinical challenges and outcomes associated with delayed presentation and highlights a successful conservative management approach.

Case presentation: A 24-year-old unmarried South-Asian male with a history of cannabis use and abnormal behaviour presented with penile strangulation by a thick metallic ring of 96 h duration. Examination revealed Grade II penile injury with oedema and distal congestion. Initial decompression attempts failed. Penile block followed by aspiration of corpora cavernosa and use of feeding tubes alongside lubrication allowed successful removal via the string method. The patient developed a localized superficial infection managed with intravenous Piperacillin-Tazobactam following Escherichia coli growth in wound swab culture. He responded well and was discharged on postoperative day 7.

Clinical discussion: Penile strangulation requires individualized treatment based on severity. Minimally invasive techniques like aspiration and string method are effective for low-grade injuries. Literature supports emerging techniques involving non-traditional tools such as dental drills and air cutters, particularly in delayed or complex presentations. Complications like infection and necrosis are more common with delayed presentation, emphasizing the need for early intervention and public awareness.

Conclusion: Early recognition, appropriate technique selection, and multidisciplinary care are key to preventing long-term sequelae. This case reinforces the effectiveness of conservative decompression methods in low-grade injuries despite delayed presentation.

Introduction and importance: True postero-lateral ventricular aneurysm occurring in the submitral position is a rare entity and is usually of congenital etiology. Large aneurysms strongly alter cardiac geometry and impair cardiac systolic and diastolic function, resulting in various complications.

Case presentation: We report a case presenting with cardiogenic shock due to the rupture of a large postero-lateral LV aneurysm, successfully managed by emergent surgery and aneurysmectomy. The preoperative trans-thoracic echocardiographic evaluation showed a large size pericardial effusion with large submitral round aneurysm with a thin wall along the postero-lateral border of the LV. The patient was scheduled for emergent operation with high suspicion of post MI lateral free wall rupture and tamponade.

Clinical discussion: The presented case is very interesting regarding challenge of diagnosis and successful surgical intervention as to date very rare cases of true posterolateral LV aneurysm rupture have been reported in the literature.

Conclusion: Coronary angiography and pathologic examination in this case revealed that the etiology of the patient's posterolateral LV aneurysm might be a silent myocardial infarction in LCX territory, although a less common congenital origin cannot be ruled out completely.

Introduction: In selected patients, transcatheter closure of atrial septal defects (ASD) with atrial septal occluder (ASO) devices has showed outstanding results. However, in very rare cases, there is a risk of device embolization.

Presentation of case: This case is of a 16-year-old female, who presented to the paediatric outpatient department with acute abdominal pain. As a 9-year-old she was treated for an ASD with the implantation of ASO device. Five months after the treatment, the ASO was found to be embolised to the abdominal aorta. Another ASO device was implanted but transcatheter retrieval of the embolised ASO device was unsuccessful. Due to the very young age of the patient and her being asymptomatic, the patient was indicated for conservative management. The patient was asymptomatic for 7 years, where after the patient started having acute abdominal pain attacks and postprandial nausea, for which the surgical retrieval was indicated and successfully performed by open aortic surgery.

Discussion: Device embolization, reported in up to 0.5 % of cases, can be potentially fatal. In most cases, embolization occurs in the first 72 h, and immediate transcatheter retrieval is recommended, with open surgery being an efficient alternative if transcatheter retrieval fails.

Conclusion: ASO device embolization should be promptly diagnosed and treated by a multidisciplinary team to achieve the best results. Open surgical retrieval of the occluder devices is a safe and a highly effective alternative method to retrieve embolised devices when transcatheter retrieval fails.

Introduction and importance: Intussusception of an appendiceal mucocele is an extremely rare condition, reported in approximately 0.01 % of appendectomy cases. Its preoperative diagnosis remains very difficult due to nonspecific clinical and radiological findings. Surgical management with only an appendectomy is considered adequate when the appendiceal base is not involved.

Case presentation: A 45-year-old female patient presented with recurrent episodes of lower abdominal pain lasting over two weeks, accompanied by decreased appetite and dysuria. The patient underwent an appendectomy, and the specimen was submitted for histopathological examination.

Clinical discussion: Mucocele of the appendix as a cause of intussusception is uncommon; it usually presents with nonspecific abdominal or urinary symptoms but can be identified through sonography. The gold standard remains CT; however, due to the war situation in this case, diagnosis relies on sonographic features such as the onion-skin sign. Surgical intervention depends on tumour size; if a malignant tumour is suspected, a right hemicolectomy should be carried out for better margin control.

Conclusion: Intussusception of the appendiceal mucocele is uncommon and presents considerable diagnostic difficulties, especially before surgery. These difficulties are especially evident in resource-limited settings, including conflict zones and low- and middle-income countries (LMICs).

Introduction: Testicular trauma, accounting for up to 66 % of urological injuries, mainly affects males aged 15 to 40 due to sports, violence, and traffic accidents. Rupture occurs in 48 % to 60 % of blunt injuries, often involving the right testis. Early ultrasonographic diagnosis and prompt surgical exploration are vital to prevent complications, infertility, or orchiectomy.

Case presentations: A 57-year-old man presented with a three-month history of right-sided scrotal swelling following blunt perineal trauma from a fall. Initial treatment with analgesics and antibiotics from lower level health facilities relieved pain but not swelling. Examination revealed a non-tender, irreducible right scrotal mass with a non-palpable right testis. Ultrasound showed a large, mixed-echo fluid collection with increased peripheral vascularity. Laboratory results were normal. A differential diagnosis of scrotal haematoma versus abscess was made, prompting surgical exploration. Intraoperatively, a 150 mL old haematoma and a ruptured right testis (AAST grade V) with torn tunica albuginea, extruded seminiferous tubules, and necrotic tissue were found. A right orchiectomy and debridement were performed. Hemostasis was achieved, and layered closure of the scrotum was completed using absorbable sutures. The postoperative course was uneventful, and at one-month follow-up, the patient had recovered well. Early evaluation and surgical intervention were key to an optimal outcome in this case of delayed testicular rupture.

Discussion: Blunt testicular trauma, although rare, requires early ultrasonographic assessment and immediate surgical exploration to maximise testicular salvage and minimise orchiectomy rates. Ruptures often occur from sports or falls, with atypical presentations making diagnosis more difficult. The AAST grading system informs treatment, and early intervention enhances fertility, hormonal function, and psychosocial outcomes.

Conclusion: Testicular rupture is uncommon but serious, requiring prompt assessment to optimise testicular preservation, especially in high-risk patients.