International Journal of Surgery Case Reports最新文献_第5页

Tranexamic acid induced seizure during spine surgery: A case report 脊柱手术中氨甲环酸诱发癫痫发作1例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-31 DOI: 10.1016/j.ijscr.2025.112133

Thomas J. Ryan , Christopher Lucasti , Danielle E. Chipman , Emily K. Vallee , Maxwell M. Scott , Joseph M. Kowalski

Introduction and importance

The management of perioperative blood loss is a significant concern in spine surgery, directly affecting patient recovery and outcomes. Tranexamic acid (TXA) is widely used to minimize intraoperative bleeding and reduce the need for transfusions. Despite its benefits, TXA can pose risks, including rare but severe complications such as seizures. Understanding the balance between its hemostatic advantages and potential adverse effects is critical. This case discusses a 66-year-old female who experienced a generalized tonic-clonic seizure after TXA administration during spine surgery.

Presentation of case

A 66-year-old female with a history of hypertension, diabetes, depression, anxiety, and multiple spine surgeries presented with severe back and hip pain after a fall. She was found to have a fracture through her posterior fusion mass at L1–2. She underwent T10-L5 reinstrumentation, fusion, and L1-L2 laminectomy. She received a standard bolus of TXA and after being flipped supine developed a generalized tonic-clonic seizure which was controlled with propofol and versed. She experienced a subsequent seizure and PEA while in the CT suite, followed by successful resuscitation. She was discharged uneventfully to rehab with neurology follow up.

Clinical discussion

TXA is effective in reducing surgical blood loss but can cause seizures by crossing the cerebrovascular barrier and antagonizing gamma-aminobutyric acid (GABA) receptors in the central nervous system (CNS). The incidence of TXA-induced seizures is rare, particularly in orthopedic surgery.

Conclusion

Careful preoperative assessment and vigilant perioperative monitoring are essential when utilizing TXA in spine surgery. Increased awareness and prompt management of seizures can improve patient outcomes.

前言和重要性围手术期失血的处理是脊柱外科的一个重要问题，直接影响患者的康复和预后。氨甲环酸（TXA）广泛用于减少术中出血和减少输血的需要。尽管它有好处，但TXA也会带来风险，包括罕见但严重的并发症，如癫痫发作。了解其止血优势和潜在副作用之间的平衡是至关重要的。本病例讨论了一位66岁的女性，她在脊柱手术中服用TXA后出现全身性强直阵挛性癫痫发作。患者66岁，女性，有高血压、糖尿病、抑郁、焦虑和多次脊柱手术史，跌倒后出现严重的背部和臀部疼痛。患者在L1-2后路融合肿块处发现骨折。患者接受了T10-L5椎板内固定术、融合术和L1-L2椎板切除术。她接受了标准剂量的TXA，在翻转仰卧后出现了全身性强直阵挛性癫痫发作，用异丙酚和缬草控制。她在CT套件中经历了随后的癫痫发作和PEA，随后成功复苏。她顺利出院，接受神经病学随访。txa可有效减少手术失血量，但可通过穿过脑血管屏障和拮抗中枢神经系统（CNS）的γ -氨基丁酸（GABA）受体而引起癫痫发作。txa诱发癫痫发作的发生率是罕见的，特别是在骨科手术。结论在脊柱外科应用TXA时，术前评估和围手术期监测是必要的。提高对癫痫发作的认识和及时管理可以改善患者的预后。

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引用次数: 0

Use of repository corticotropin injection for the prophylaxis of corneal graft rejection in high-risk patients: A case series 使用储存库促肾上腺皮质激素注射预防高危患者角膜移植排斥反应：一个病例系列

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-31 DOI: 10.1016/j.ijscr.2025.112140

Steven M. Silverstein

Introduction

Graft rejection is the leading cause of corneal allograft failure. Prompt recognition followed by aggressive steroid therapy are key elements in the treatment of graft rejection; however, prolonged corticosteroid use carries an unfavorable safety profile. Repository corticotropin injection (RCI) is United States Food and Drug Administration (FDA)-approved for the treatment of several inflammatory disease states and is indicated for use in severe ophthalmic acute and chronic allergic and inflammatory processes. In this consecutive, observational case report we provide descriptive results of the use of RCI as prophylaxis for corneal graft rejection in high-risk patients.

Presentation of cases

Eligible high-risk patients were administered 80 units of RCI subcutaneously twice weekly beginning one-month pretransplant. Preoperative visual acuity (VA) and postoperative intraocular pressure, graft integrity, and VA values were collected for all patients.

Discussion

The majority of patients (87.5 %) receiving RCI demonstrated maintenance or improvement of VA post-keratoplasty as well as post-operative intraocular pressures that fell within the normal range. Upon postoperative examination, the majority of patients (6/8; 75 %) treated with RCI maintained a clear graft quality with no signs of rejection. No treatment-emergent adverse effects were reported by the patients during treatment with RCI.

Conclusion

The use of RCI prophylactically in high-risk, post-keratoplasty patients demonstrated maintenance or improvement in VA in the majority of patients. The results of this study also showed that RCI was safe and well tolerated, which is consistent with the known safety profile of RCI.

移植排斥反应是角膜移植失败的主要原因。及时识别和积极的类固醇治疗是治疗移植物排斥反应的关键因素；然而，长期使用皮质类固醇具有不利的安全性。储存库促肾上腺皮质激素注射液（RCI）是美国食品和药物管理局（FDA）批准用于治疗几种炎症性疾病状态，并适用于严重的眼科急性和慢性过敏和炎症过程。在这篇连续的观察性病例报告中，我们提供了使用RCI预防高风险患者角膜移植排斥反应的描述性结果。符合条件的高危患者从移植前一个月开始，每周两次皮下注射80单位RCI。收集所有患者术前视力（VA）、术后眼压、移植物完整性和VA值。大多数接受RCI的患者（87.5%）在角膜移植术后VA维持或改善，术后眼压降至正常范围内。术后检查，大多数接受RCI治疗的患者（6/8;75%）保持了清晰的移植物质量，无排斥反应迹象。患者在RCI治疗期间未报告出现治疗不良反应。结论在角膜移植术后的高危患者中预防性使用RCI可维持或改善大多数患者的VA。本研究结果还表明，RCI是安全且耐受性良好的，这与已知的RCI安全性一致。

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引用次数: 0

Acute sciatic nerve palsy secondary to postoperative seroma following soft tissue sarcoma resection: A case report 软组织肉瘤切除术后血清肿继发急性坐骨神经麻痹1例

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-31 DOI: 10.1016/j.ijscr.2025.112132

Ahmad Hammad , Rakan Nassereddine , Said Saghieh

Introduction and importance

Seroma is a common complication following soft tissue sarcoma resection of lower extremity and might cause functional limitation, infection, prolonged postoperative course and delay in adjuvant treatment. This study aims to report on acute sciatic nerve palsy secondary to postoperative collection following soft tissue sarcoma resection.

Case presentation

A 70-year-old male underwent radical re-resection of recurrent liposarcoma of right thigh with end-to-end anastomosis of femoral vein and artery. It was complicated by deep vein thrombosis and pulmonary embolism requiring therapeutic anticoagulation. On day 12 postoperatively, the patient developed seroma/hematoma compressing the sciatic nerve and resulting in complete paralysis and loss of sensation. An emergent incision and drainage with evacuation of the collection was performed. The patient regained near complete neurological function and was maintained on therapeutic anticoagulation.

Clinical discussion

Seroma formation following STS resection results in a complex postoperative course with a prolonged hospital stay, functional limitations, wound complications and delayed adjuvant treatment. Acute sciatic nerve palsy secondary to compartment syndrome is a serious complication that can lead to worse outcomes requiring close follow-up and intervention. There is no consensus on the appropriate treatment and several options exist ranging from non-operative drain application and needle aspiration to surgical evacuation and debridement.

Conclusion

Acute sciatic nerve palsy is a rare complication secondary to compression by seroma/hematoma following soft tissue sarcoma resection. The latter complication is reversible with adequate monitoring and prompt timely intervention especially in patients using potent anticoagulants.

介绍及重要性下肢软组织肉瘤切除术后常见的并发症是浆肿，可引起功能限制、感染、术后病程延长和辅助治疗延迟。本研究旨在报道软组织肉瘤切除术后继发于术后采集的急性坐骨神经麻痹。一例70岁男性患者行右大腿复发性脂肪肉瘤根治性再切除术，股静脉、股动脉端对端吻合。并发深静脉血栓和肺栓塞，需要抗凝治疗。术后第12天，患者出现血肿/血肿压迫坐骨神经，导致完全瘫痪和感觉丧失。我们进行了紧急切口和引流术，并将收集的标本全部取出。患者恢复了几乎完全的神经功能，并继续使用抗凝治疗。临床讨论：STS切除术后血清肿形成导致复杂的术后过程，包括住院时间延长、功能限制、伤口并发症和辅助治疗延迟。急性坐骨神经麻痹继发于筋膜室综合征是一种严重的并发症，可导致较差的结果，需要密切的随访和干预。对于合适的治疗方法尚无共识，存在几种选择，从非手术引流和针吸到手术清除和清创。结论急性坐骨神经麻痹是软组织肉瘤切除术后血清肿/血肿压迫所致的罕见并发症。后一种并发症在充分监测和及时干预下是可逆的，特别是在使用强效抗凝剂的患者中。

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引用次数: 0

Left-sided perforated appendicitis in a 22-year-female with intestinal malrotation: A case report from a resource-limited setting 左侧穿孔阑尾炎22岁女性肠旋转不良：一例报告从资源有限的设置

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-30 DOI: 10.1016/j.ijscr.2025.112123

Abdulrahman Mohammed Abdulrahman Abouh , Ahmed Idris Abdelrahman Idris , Arwa Mohammed Abdallah Gomaa , Hussain Gadelkarim Ahmed

Introduction and importance

A left-sided appendicitis is rare and usually caused by congenital anomalies such as intestinal malrotation or situs inversus. Diagnosis can be particularly challenging in low-resource settings where imaging such as CT is unavailable.

Presentation of case

A 22-year-old female presented with periumbilical pain that migrated to left iliac fossa area over five days. Due to the lack of CT imaging, clinical evaluation led to a diagnosis of acute abdomen. Emergency laparotomy revealed a perforated appendix located in the left lower quadrant due to intestinal malrotation. Appendectomy was performed, and the patient recovered uneventfully. Her last menstrual period was one week before admission, and gynecologic causes were considered in the differential diagnosis but excluded intraoperatively.

Clinical discussion

As a result of this case, appendicitis should be considered in the differential diagnosis of left-sided abdominal pain. The intraoperative recognition of malrotation emphasizes the importance of surgical awareness of anatomical variations, particularly when preoperative imaging is lacking.

Conclusion

The diagnosis of left-sided perforated appendicitis is rare, but should be considered in patients with atypical abdominal pain. In resource-limited environments, clinical judgment and timely surgical exploration are essential.

简介及重要性左侧阑尾炎是罕见的，通常由先天性异常引起，如肠旋转不良或肠倒位。在缺乏CT等影像的低资源环境中，诊断尤其具有挑战性。病例介绍：一位22岁的女性，在5天的时间里表现为脐周疼痛，并转移到左髂窝区。由于缺乏CT成像，临床评估导致诊断为急腹症。急诊剖腹手术发现由于肠道旋转不良，阑尾位于左下腹穿孔。阑尾切除术后，患者顺利康复。最后一次月经为入院前一周，在鉴别诊断时考虑妇科原因，术中排除。临床讨论由于本病例，阑尾炎在左腹痛的鉴别诊断中应被考虑。术中对旋转不良的识别强调了手术对解剖变异的认识的重要性，特别是在术前缺乏影像学检查的情况下。结论左侧穿孔性阑尾炎诊断罕见，但在不典型腹痛患者中应予以重视。在资源有限的环境下，临床判断和及时的手术探查是必不可少的。

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引用次数: 0

Efficacy and safety of single-incision laparoscopic ileocecal resection using a dome port: A novel device: A case report 单切口腹腔镜回盲切除术的有效性和安全性：一种新型装置：1例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-30 DOI: 10.1016/j.ijscr.2025.112096

Shingo Ito, Tomohiro Yamamoto, Shota Akabane, Yuma Suno, Kei Hosoda, Shoichi Fujii

Introduction and importance

This is the first case report of single-incision laparoscopic surgery using the Dome Port for colon cancer. Dome Port is designed to enhance the operability and safety of single-incision surgery. The key advantages are as follows. First, this device is made of transparent silicone, allowing the surgeon to directly visualize the insertion of surgical instruments. Second, the flexible silicone material minimizes interference between surgical instruments and the port.

Case presentation

A 70-year-old female visited our hospital with occult blood test positive. She underwent a myoma resection approximately 20 years ago. A lower midline abdominal incision was present. Preoperative examination revealed the presence of advanced tumor in the cecum colon. Ileocecal resection was performed as the laparoscopic single-port technique using Dome Port. The procedure was performed safely, with an operation time of 138 min. The patient experienced minimal postoperative pain and resumed oral intake on postoperative day 2. The patient was discharged on postoperative day 6 without major complications.

Clinical discussion

The Dome Port's transparent silicone construction allowed direct visualization of instrument insertion, enhancing procedural safety, while its flexible material minimized instrument interference and improved ergonomic manipulation. Compared to conventional single-incision ports, these features may reduce operative difficulty and the risk of instrument collisions, potentially contributing to smoother workflows and lower complication rates.

Conclusion

The Dome Port was effective for single-incision laparoscopic ileocecal resection and may facilitate safer surgical procedures. It is expected to become one of the options for future reduced port surgery.

介绍及重要性本文报道首例单切口腹腔镜手术经Dome口治疗结肠癌的病例。Dome Port旨在提高单切口手术的可操作性和安全性。主要优点如下。首先，这个装置是由透明硅胶制成的，允许外科医生直接看到手术器械的插入。其次，柔性硅胶材料最大限度地减少了手术器械和端口之间的干扰。病例介绍：一名70岁女性以潜血试验阳性来我院就诊。她大约在20年前做了子宫肌瘤切除术。腹部中线下有切口。术前检查发现盲肠结肠存在晚期肿瘤。回盲切除术采用腹腔镜单孔技术，采用Dome Port。手术过程安全，手术时间为138分钟。患者术后疼痛最小，术后第2天恢复口服。患者于术后第6天出院，无重大并发症。Dome Port的透明硅胶结构允许直接可视化器械插入，提高手术安全性，而其柔性材料最大限度地减少了器械干扰并改善了人体工程学操作。与传统的单切口端口相比，这些特征可以降低手术难度和器械碰撞的风险，可能有助于更顺畅的工作流程和更低的并发症发生率。结论Dome Port在单切口腹腔镜回盲切除术中是有效的，可以促进更安全的手术。它有望成为未来缩口手术的选择之一。

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引用次数: 0

Benign but bizarre: A case report on idiopathic scrotal calcinosis 良性但怪异：特发性阴囊钙质沉着症1例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-28 DOI: 10.1016/j.ijscr.2025.112125

Amol Gupta, Sanjeev Gianchandani, Swati Deshpande, Vasundhara Gopalan, Jhanwi Khurana, Arushi Kaul

Introduction and importance

Calcinosis cutis, also known as calcification in soft tissue, is an uncommon benign condition that can be further classified into idiopathic, dystrophic, iatrogenic, metastatic, and calciphylaxis subtypes. The scrotum is one area where calcinosis cutis frequently occurs. During years or decades, the nodules gradually enlarge. The scrotal calcinosis cutis can be solitary or multiple, typically asymptomatic, hard, yellowish marble-like, polypoidal. Despite being benign, patients with this condition present late due to shyness or cancer anxiety, even when faced with sexual discomfort and infertility. In this article, we want to raise awareness to highlight benignity of this condition, various treatment options and good prognosis associated with the disease.

Case presentation

A 38-year-old male presented with multiple painful, itchy scrotal swellings and infertility. Examination revealed scrotal nodules, absent left testis, and aspermia. Histopathology confirmed scrotal calcinosis. Total scrotectomy was performed with right testis repositioned in the thigh. Patient was referred for infertility management after successful surgical recovery.

Clinical discussion

Idiopathic calcinosis cutis of the scrotum (ICCS) is a benign, slow-growing condition often presenting in adulthood with asymptomatic yellowish nodules. Diagnosis is confirmed histologically. Though idiopathic, it may involve dystrophic calcification of epidermoid cysts. Surgical excision with scrotal reconstruction is the preferred treatment, offering excellent cosmetic and curative outcomes.

Conclusion

Being usually asymptomatic, ICCS is a benign disorder. It appears as a series of successive, different-sized nodules. A histological evaluation shows the calcified regions. One of two possible causes exists: idiopathic or dystrophic calcification of cysts. Excision is the preferred course of action.

皮肤钙化病，又称软组织钙化，是一种罕见的良性疾病，可进一步分为特发性、营养不良型、医源性、转移性和钙化反应亚型。阴囊是皮肤钙质沉着症常发生的部位之一。在数年或数十年间，结节逐渐扩大。阴囊钙质沉着症可单发或多发，典型无症状，硬，淡黄色大理石样，息肉状。尽管是良性的，但由于害羞或癌症焦虑，即使面临性不适和不孕，患者也会出现较晚的症状。在这篇文章中，我们希望提高人们的认识，强调这种疾病的良性，各种治疗选择和良好的预后。病例表现：男性，38岁，阴囊肿胀多处痛、痒、不孕症。检查发现阴囊结节，左侧睾丸缺失，以及贫血。组织病理学证实为阴囊钙质沉着症。行全阴囊切除术，右睾丸复位于大腿。患者手术恢复成功后转介不孕症治疗。临床讨论特发性阴囊皮肤钙质沉着症（ICCS）是一种良性、生长缓慢的疾病，通常在成年期出现无症状的淡黄色结节。病理证实诊断。虽然是特发性的，但它可能涉及表皮样囊肿的营养不良钙化。手术切除与阴囊重建是首选的治疗方法，提供良好的美容和治疗效果。结论ICCS是一种良性疾病，通常无症状。它表现为一系列连续的不同大小的结节。组织学检查显示钙化区。两种可能的原因之一存在：特发性或营养不良的钙化囊肿。切除是首选的治疗方法。

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引用次数: 0

Impact of cervical lymph node dissection on accessory spinal nerve XI function: Case series and literature review 颈淋巴结清扫对副脊神经XI功能的影响：病例分析及文献复习

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-28 DOI: 10.1016/j.ijscr.2025.112122

Saout Arrih Badr, Bijou Walid, Oukessou Youssef, Rouadi Sami, Abada Reda, Mahtar Mohamed

Introduction

Cervical lymph node dissection can damage the accessory spinal nerve, causing motor and pain disorders. This study evaluates the impact of these lesions and investigates the associated risk factors.

Methods

Prospective study of 29 patients who underwent cervical lymph node dissection. Assessment of accessory spinal nerve function was performed by clinical examination and electromyogram on day 28 and 6 months post-operatively. The EMG parameters analyzed were onset latency and motor amplitude. Electrophysiological and clinical criteria were established to distinguish neurapraxia from axonotmesis: neurapraxia was defined by conduction block with normal distal latencies (<3 ms) and preserved amplitudes (>5 mV), while axonotmesis was characterized by prolonged latencies (≥3 ms) and reduced amplitudes (≤5 mV) with signs of axonal degeneration. Statistical analysis was performed using Mann-Whitney, Wilcoxon, and McNemar tests and linear regression (p < 0.05).

Results

Damage to the accessory spinal nerve was common after cervical lymph node dissection: trapezius atrophy (72 %), scapular detachment (32 %), C2 hypoesthesia (34 %). EMG revealed a mean latency of 2.78 ms (34 % pathological) and a mean amplitude of 3.04 mV (84 % less than 5 mV). Malignant pathology significantly influenced EMG amplitude (p = 0.026). At 6 months, significant improvement was observed: recovery of joint amplitudes, reduction in muscle atrophy (p < 0.05), reduction in hypoesthesia to 5.1 %, and improvement in EMG latencies (2.6 % pathological vs. 30.8 % initially).

Conclusion

Cervical lymph node dissection frequently causes damage to the accessory spinal nerve in the form of axonotmesis. Despite gradual clinical improvement (recovery of joint range of motion, reduction in muscle atrophy), electrophysiological abnormalities persist at 6 months, reflecting a prolonged recovery process requiring 12 to 18 months. Individual anatomical variations justify personalized management. This study highlights the importance of prolonged follow-up and appropriate preventive strategies to optimize functional recovery after dissection.

颈淋巴结清扫可损伤副脊神经，引起运动和疼痛障碍。本研究评估了这些病变的影响，并调查了相关的危险因素。方法对29例行颈部淋巴结清扫术的患者进行前瞻性研究。术后28天和6个月分别通过临床检查和肌电图评估副脊神经功能。分析的肌电参数为发病潜伏期和运动幅度。建立了区分神经失用和轴索紊乱的电生理和临床标准：神经失用的定义是传导阻滞，远端潜伏期正常（3 ms），振幅保留（5 mV），而轴索紊乱的特征是潜伏期延长（≥3 ms），振幅降低（≤5 mV），并伴有轴突变性。统计学分析采用Mann-Whitney、Wilcoxon和McNemar检验和线性回归（p < 0.05）。结果颈淋巴结清扫术后副神经损伤常见：斜方肌萎缩（72%）、肩胛骨脱离（32%）、C2感觉减退（34%）。肌电图显示平均潜伏期为2.78 ms（34%为病理性），平均振幅为3.04 mV（84%小于5 mV）。恶性病理对肌电波幅有显著影响（p = 0.026）。6个月时，观察到显著的改善：关节振幅恢复，肌肉萎缩减少（p < 0.05），感觉减退减少至5.1%，肌电图潜伏期改善（病理性2.6% vs初始30.8%）。结论颈淋巴结清扫常造成副脊神经损伤，表现为轴索压迫。尽管临床逐渐改善（关节活动范围恢复，肌肉萎缩减少），但电生理异常持续6个月，反映恢复过程延长，需要12至18个月。个体解剖差异证明了个性化治疗的合理性。本研究强调了长期随访和适当的预防策略对优化解剖后功能恢复的重要性。

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引用次数: 0

Bilateral carotid web successfully treated with endarterectomy, a case report 双侧颈动脉内膜切除术成功治疗1例

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-27 DOI: 10.1016/j.ijscr.2025.112120

Mohammed A. Sadig , Abdullah G. Alsahwan , Omar Alothman , Alwaleed S. Althobaiti , Fahad Ahmed Z. Alshammari , Faris Alomran

Introduction

A carotid web is an uncommon vascular anomaly that has been identified as an important cause of ischemic stroke in young patients with no traditional atherosclerosis risk factors. This fibrous membrane present in the internal carotid artery tends to cause turbulent flow and thrombosis. We report a case of bilateral carotid web successfully treated by carotid endarterectomy.

Case presentation

A 36-year-old female patient with a past medical history of non-epileptic seizures due to psychogenic factors and benign paroxysmal positional vertigo was presented to the emergency room with complaints of jerky movements of the right side of the body and then generalized jerky movements for 40 min. Neurological examination was unremarkable; the NIHSS score was 0. The CT scan showed an acute infarction in the right frontoinsular region. Additional imaging revealed a tiny linear defect within bilateral ICAs. Bilateral carotid webs were diagnosed upon cerebral angiogram, and the patient was diagnosed with cryptogenic stroke. She underwent right carotid endarterectomy. Postoperative recovery was uneventful, and the patient was discharged on the 3rd postoperative day. A subsequent left carotid endarterectomy was performed without complications.

Discussion

Carotid webs play a key role in ischemic strokes, especially among the young patient population. Most are asymptomatic, but some patients have symptoms of TIA or stroke. Current management options include antiplatelet therapy and surgical intervention.

Conclusion

This case highlights the importance of recognizing a carotid web as a potential cause of ischemic stroke and suggests that surgical intervention is warranted in symptomatic patients to prevent recurrent strokes. Further research is needed to optimize management strategies for this condition.

颈动脉网是一种罕见的血管异常，在没有传统动脉粥样硬化危险因素的年轻患者中被认为是缺血性脑卒中的重要原因。这种纤维膜存在于颈内动脉容易引起湍流和血栓形成。我们报告一例成功治疗双侧颈动脉壁颈动脉内膜切除术。病例表现女性，36岁，既往有心因所致非癫痫性发作及良性阵发性体位性眩晕病史，以右侧身体抽动为主诉，后出现全身抽动40分钟。神经学检查无明显异常；NIHSS评分为0。CT扫描显示右侧额岛区急性梗死。附加成像显示双侧ICAs内有微小的线状缺损。经脑血管造影诊断为双侧颈动脉网，诊断为隐源性脑卒中。她接受了右侧颈动脉内膜切除术。术后恢复顺利，患者于术后第3天出院。随后进行左侧颈动脉内膜切除术，无并发症。颈动脉网在缺血性中风中起关键作用，尤其是在年轻患者群体中。大多数患者无症状，但一些患者有TIA或中风的症状。目前的治疗方案包括抗血小板治疗和手术干预。结论：该病例强调了认识到颈动脉网是缺血性卒中的潜在原因的重要性，并提示对有症状的患者进行手术干预是必要的，以防止卒中复发。需要进一步的研究来优化这种情况的管理策略。

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引用次数: 0

Tube ileostomy technique successfully preserved the ileocecal region in a case of fetal intestinal volvulus without malrotation: A case report 输卵管回肠造口术成功保存了1例胎儿肠扭转无旋转不良的回盲区

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-27 DOI: 10.1016/j.ijscr.2025.112121

Kohei Kawaguchi , Seiichiro Inoue , Yuki Muta , Yuta Takeuchi , Akio Odaka

Introduction and importance

Preserving the ileocecal valve in terminal ileal necrosis is crucial to prevent bile acid malabsorption and growth impairment. Fetal intestinal volvulus without malrotation (IVWM) is rare. This report highlights successful valve preservation via tube ileostomy in a neonate with IVWM, offering practical insight into neonatal bowel management.

Presentation of case

A male neonate was delivered by emergency cesarean section at 37 weeks due to antenatal bowel dilation. A whirlpool sign on ultrasound prompted laparotomy, revealing a 1080-degree volvulus 2 cm distal to the ileocecal valve without malrotation. Thirty-two centimeters of necrotic ileum were resected. Due to inflammation, anastomosis was not feasible; an end ileostomy and distal tube ileostomy were performed, preserving 55 cm of proximal bowel and 2 cm distal to the valve. Weight gain improved following parenteral nutrition and stool recycling. Contrast study on day 53 confirmed distal patency, and reanastomosis was completed on day 94. The patient was discharged 47 days later.

Clinical discussion

When immediate anastomosis is not feasible, distal closure is often chosen. This case shows that tube ileostomy with stool recycling can preserve function even with minimal distal ileum, supporting growth and adaptation.

Conclusion

Tube ileostomy enabled valve preservation and a favorable outcome.

在回肠终末坏死中保留回盲瓣对防止胆汁酸吸收不良和生长损害至关重要。胎儿肠扭转无旋转不良（IVWM）是罕见的。本报告强调通过试管回肠造口成功保存IVWM新生儿的瓣膜，为新生儿肠道管理提供实用的见解。病例介绍一例男婴因产前肠扩张于37周时急诊剖宫产。超声显示漩涡征，提示剖腹手术，在回盲瓣远端2cm处发现1080度扭转，但没有旋转不良。切除32厘米坏死回肠。由于炎症，无法吻合；进行末端回肠造口术和远端回肠管造口术，保留近端肠55 cm和远端瓣膜2 cm。肠外营养和粪便循环后体重增加有所改善。第53天的对比研究证实远端通畅，第94天完成吻合。患者于47天后出院。当不能立即吻合时，常选择远端闭合。本病例表明，管式回肠造口伴粪便循环可以保留功能，即使是最小的远端回肠，支持生长和适应。结论管式回肠造口术可保留瓣膜，预后良好。

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引用次数: 0

A rare presentation of adult colonic intussusception secondary to a descending colon lipoma: A case report 成人结肠肠套叠继发于降结肠脂肪瘤一例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-27 DOI: 10.1016/j.ijscr.2025.112119

Biniam E. Zelelew , Dereje G. Andargie , Chernet T. Mengistie , Biruk T. Mengistie , Anteneh Gadisa , Abel G. Wubie

Introduction and importance

Adult colonic intussusception is a rare and often diagnostically challenging condition, typically associated with a pathological lead point. While malignant tumors are more common causes in adults, benign lesions like colonic lipomas can also be responsible, albeit infrequently.

Case presentation

We report a case of a 54-year-old woman presenting with intermittent left lower abdominal pain and recent rectal bleeding. Contrast-enhanced abdominal CT demonstrated an incomplete descending colon intussusception with a fat-density mass as the lead point. She underwent a left hemicolectomy. Histopathology revealed a 4.2 × 4.3 cm pedunculated submucosal lipoma with no malignancy. Her postoperative course was uneventful, and she made a full recovery.

Clinical discussion

Adult intussusception often requires surgical intervention due to the high likelihood of underlying malignancy. Preoperative imaging, particularly CT, plays a crucial role in diagnosis and identifying the nature of the lead point. In this case, a benign lipoma caused the intussusception, but surgical resection was still warranted to exclude malignancy and relieve symptoms.

Conclusion

Though rare, colonic lipomas should be considered in adult intussusception cases. Cross-sectional imaging is essential for diagnosis, and surgical resection remains the mainstay of treatment. Early recognition and intervention can lead to excellent outcomes, as demonstrated in this case.

成人结肠肠套叠是一种罕见且常具有诊断挑战性的疾病，通常与病理导点相关。虽然恶性肿瘤在成人中更常见，但像结肠脂肪瘤这样的良性病变也可能是病因，尽管不常见。我们报告一例54岁女性，以间歇性左下腹疼痛和近期直肠出血为主诉。腹部增强CT显示不完全降结肠肠套叠，以脂肪密度肿块为先导点。她接受了左结肠切除术。病理组织学显示为一4.2 × 4.3 cm带针的粘膜下脂肪瘤，无恶性肿瘤。她的术后过程很顺利，她完全康复了。临床讨论成人肠套叠因其潜在恶性肿瘤的可能性高，常需要手术治疗。术前影像学，特别是CT，在诊断和确定导点的性质方面起着至关重要的作用。本例为良性脂肪瘤引起肠套叠，但仍需手术切除以排除恶性肿瘤及缓解症状。结论成人肠套叠虽罕见，但仍应考虑结肠脂肪瘤。横断成像对于诊断是必不可少的，手术切除仍然是治疗的主要方法。正如本例所示，早期识别和干预可以带来良好的结果。

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引用次数: 0