International Journal of Surgery Case Reports最新文献_第6页

Right sided testicular pain as the sole presenting symptom of an abdominal aortic aneurysm: A case report 右侧睾丸疼痛为腹主动脉瘤的唯一表现症状：1例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-27 DOI: 10.1016/j.ijscr.2025.112130

Fred Kenny, Morgan McLoughlin, Simona Bobic, Fergal Moran, Galina Ponomareva, Nawar Masarani

Introduction and importance

This case highlights the rare presentation of testicular pain in a patient with a symptomatic abdominal aortic aneurysm (sAAA). Atypical presentations provide diagnostic challenges for timely diagnosis. This case report aims to show the importance of considering sAAA in the differential diagnosis of testicular pain, especially in older patients with known cardiovascular risk factors. Prompt diagnosis and early intervention are critical to improving outcomes in cases of ruptured abdominal aortic aneurysms (rAAA).

Presentation of case

A 62-year-old male with a medical history of hypertension, hyperlipidaemia, and prostate cancer presented to the emergency department with sudden-onset right-sided testicular pain. On initial examination, the patient had a soft abdomen with mild lower abdominal tenderness and Point of Care Ultrasound (POCUS) identified a 9.1 cm abdominal aortic aneurysm. A 9.4 cm infrarenal sAAA was subsequently confirmed on a Computed Tomography (CT) Aorta. The patient initially remained hemodynamically stable, but shortly afterwards developed hypotension, confusion, and worsening pain. A repeat CTA revealed retroperitoneal haemorrhage, indicating a rupture of the aneurysm. The patient underwent an emergency open aneurysm repair.

Clinical discussion

Abdominal aortic aneurysms (rAAAs) often present atypically, leading to diagnostic delays. A large meta-analysis has shown misdiagnosis rates as high as 42 % [1], commonly mistaken for urological or gastrointestinal conditions. This case demonstrates the importance of early recognition of atypical symptoms, such as isolated testicular pain, to avoid misdiagnosis and enable timely intervention. The referred pain was likely mediated via the genitofemoral nerve, irritated by the aneurysm and adjacent hematoma.

Conclusion

Given the high mortality associated with rAAA, early recognition of atypical symptoms, including testicular pain, is crucial. Time to diagnosis and prompt management remain crucial determinants of outcomes in rAAA [2]. This case highlights the importance of maintaining a broad differential diagnosis in patients with testicular pain.

本病例强调了有症状的腹主动脉瘤（sAAA）患者出现睾丸疼痛的罕见表现。非典型表现为及时诊断提供了诊断挑战。本病例报告旨在表明考虑sAAA在睾丸疼痛鉴别诊断中的重要性，特别是在已知心血管危险因素的老年患者中。及时诊断和早期干预对于改善腹主动脉瘤破裂（rAAA）的预后至关重要。病例介绍：一名62岁男性，有高血压、高脂血症和前列腺癌病史，因右侧睾丸突然疼痛来到急诊科。初步检查时，患者腹部柔软，腹部轻度压痛，护理点超声（POCUS）发现一个9.1厘米的腹主动脉瘤。随后在CT主动脉上证实了9.4 cm的肾下sAAA。患者最初血流动力学稳定，但不久出现低血压、精神错乱和疼痛加重。重复CTA显示腹膜后出血，提示动脉瘤破裂。病人接受了急诊开放性动脉瘤修复术。腹主动脉瘤（rAAAs）通常表现不典型，导致诊断延迟。一项大型荟萃分析显示，误诊率高达42%，通常被误诊为泌尿或胃肠道疾病。该病例表明早期识别非典型症状（如孤立性睾丸疼痛）对于避免误诊和及时干预的重要性。涉及的疼痛可能是通过生殖股神经介导的，由动脉瘤和邻近的血肿刺激。结论考虑到rAAA的高死亡率，早期识别非典型症状，包括睾丸疼痛，是至关重要的。诊断时间和及时治疗仍然是rAAA bbb预后的关键决定因素。本病例强调了在睾丸疼痛患者中保持广泛鉴别诊断的重要性。

{"title":"Right sided testicular pain as the sole presenting symptom of an abdominal aortic aneurysm: A case report","authors":"Fred Kenny, Morgan McLoughlin, Simona Bobic, Fergal Moran, Galina Ponomareva, Nawar Masarani","doi":"10.1016/j.ijscr.2025.112130","DOIUrl":"10.1016/j.ijscr.2025.112130","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>This case highlights the rare presentation of testicular pain in a patient with a symptomatic abdominal aortic aneurysm (sAAA). Atypical presentations provide diagnostic challenges for timely diagnosis. This case report aims to show the importance of considering sAAA in the differential diagnosis of testicular pain, especially in older patients with known cardiovascular risk factors. Prompt diagnosis and early intervention are critical to improving outcomes in cases of ruptured abdominal aortic aneurysms (rAAA).</div></div><div><h3>Presentation of case</h3><div>A 62-year-old male with a medical history of hypertension, hyperlipidaemia, and prostate cancer presented to the emergency department with sudden-onset right-sided testicular pain. On initial examination, the patient had a soft abdomen with mild lower abdominal tenderness and Point of Care Ultrasound (POCUS) identified a 9.1 cm abdominal aortic aneurysm. A 9.4 cm infrarenal sAAA was subsequently confirmed on a Computed Tomography (CT) Aorta. The patient initially remained hemodynamically stable, but shortly afterwards developed hypotension, confusion, and worsening pain. A repeat CTA revealed retroperitoneal haemorrhage, indicating a rupture of the aneurysm. The patient underwent an emergency open aneurysm repair.</div></div><div><h3>Clinical discussion</h3><div>Abdominal aortic aneurysms (rAAAs) often present atypically, leading to diagnostic delays. A large meta-analysis has shown misdiagnosis rates as high as 42 % [<span><span>1</span></span>], commonly mistaken for urological or gastrointestinal conditions. This case demonstrates the importance of early recognition of atypical symptoms, such as isolated testicular pain, to avoid misdiagnosis and enable timely intervention. The referred pain was likely mediated via the genitofemoral nerve, irritated by the aneurysm and adjacent hematoma.</div></div><div><h3>Conclusion</h3><div>Given the high mortality associated with rAAA, early recognition of atypical symptoms, including testicular pain, is crucial. Time to diagnosis and prompt management remain crucial determinants of outcomes in rAAA [<span><span>2</span></span>]. This case highlights the importance of maintaining a broad differential diagnosis in patients with testicular pain.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"137 ","pages":"Article 112130"},"PeriodicalIF":0.7,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intrathyroidal oncocytic parathyroid adenoma in an adult: A diagnostic challenge - Case report 成人甲状旁腺甲状腺内嗜瘤性腺瘤：一个诊断挑战-病例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-27 DOI: 10.1016/j.ijscr.2025.112124

R. Bouatay , F. Farhat , Jamel Koubaa

Introduction and importance

Intrathyroidal parathyroid adenoma ((IPAs) is a rare localization of parathyroid adenomas, potentially leading to both diagnostic and therapeutic challenges. We report a case of primary hyperparathyroidism revealed by bone and joint pain, with an atypical intrathyroidal location of the oncocytic parathyroid adenoma.

Case presentation

A 72-year-old woman was admitted for evaluation and management of chronic bone and joint pain. Laboratory tests revealed hypercalcemia associated with elevated parathyroid hormone (PTH) levels. Cervical ultrasound showed a 3 cm right lobar nodule classified as EU-TIRADS 3. Technetium-99 m sestamibi (MIBI) scintigraphy demonstrated intense uptake at the same location, raising suspicion of either thyroid or parathyroid origin. The patient underwent a right loboisthmectomy. Definitive histological analysis confirmed a 3 cm intrathyroid parathyroid adenoma. Postoperative evolution was favorable, with normalization of serum calcium and PTH levels.

Clinical discussion

Despite their rarity, IPAs hold significant clinical importance, as their atypical location within the thyroid parenchyma can lead to failed surgical explorations if not properly considered.

Conclusion

This case illustrates the rarity and diagnostic complexity of ectopic intrathyroidal oncocytic parathyroid adenomas, which can lead to failed surgical explorations. This is highlights the importance of a multimodal diagnostic approach including ultrasound, MIBI scintigraphy, and histopathology for optimal management.

简介及重要性甲状旁腺腺瘤（IPAs）是一种罕见的甲状旁腺腺瘤，可能导致诊断和治疗方面的挑战。我们报告一例原发性甲状旁腺功能亢进表现为骨和关节疼痛，甲状旁腺瘤的非典型甲状腺内位置。一名72岁的女性因慢性骨和关节疼痛而入院。实验室检查显示高钙血症与甲状旁腺激素（PTH）水平升高有关。宫颈超声示一3cm右侧大叶结节，EU-TIRADS 3型。锝- 99msestamibi （MIBI）闪烁成像显示在同一位置有强烈的摄取，引起对甲状腺或甲状旁腺起源的怀疑。患者接受了右侧额叶切除术。明确的组织学分析证实一个3厘米的甲状旁腺瘤。术后进展良好，血清钙和甲状旁腺素水平恢复正常。尽管ipa罕见，但其在临床上具有重要意义，因为如果不适当考虑，ipa在甲状腺实质内的非典型位置可能导致手术探查失败。结论本病例说明异位甲状腺内嗜瘤性甲状旁腺腺瘤的罕见性和诊断复杂性，可能导致手术探查失败。这突出了多模式诊断方法的重要性，包括超声，MIBI闪烁成像和组织病理学的最佳管理。

{"title":"Intrathyroidal oncocytic parathyroid adenoma in an adult: A diagnostic challenge - Case report","authors":"R. Bouatay , F. Farhat , Jamel Koubaa","doi":"10.1016/j.ijscr.2025.112124","DOIUrl":"10.1016/j.ijscr.2025.112124","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Intrathyroidal parathyroid adenoma ((IPAs) is a rare localization of parathyroid adenomas, potentially leading to both diagnostic and therapeutic challenges. We report a case of primary hyperparathyroidism revealed by bone and joint pain, with an atypical intrathyroidal location of the oncocytic parathyroid adenoma<strong>.</strong></div></div><div><h3>Case presentation</h3><div>A 72-year-old woman was admitted for evaluation and management of chronic bone and joint pain. Laboratory tests revealed hypercalcemia associated with elevated parathyroid hormone (PTH) levels. Cervical ultrasound showed a 3 cm right lobar nodule classified as EU-TIRADS 3. Technetium-99 m sestamibi (MIBI) scintigraphy demonstrated intense uptake at the same location, raising suspicion of either thyroid or parathyroid origin. The patient underwent a right loboisthmectomy. Definitive histological analysis confirmed a 3 cm intrathyroid parathyroid adenoma<strong>.</strong> Postoperative evolution was favorable, with normalization of serum calcium and PTH levels.</div></div><div><h3>Clinical discussion</h3><div>Despite their rarity, IPAs hold significant clinical importance, as their atypical location within the thyroid parenchyma can lead to failed surgical explorations if not properly considered.</div></div><div><h3>Conclusion</h3><div>This case illustrates the rarity and diagnostic complexity of ectopic intrathyroidal oncocytic parathyroid adenomas, which can lead to failed surgical explorations. This is highlights the importance of a multimodal diagnostic approach including ultrasound, MIBI scintigraphy, and histopathology for optimal management.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"137 ","pages":"Article 112124"},"PeriodicalIF":0.7,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Left-sided obturator hernia presenting with bowel obstruction in an elderly female: A rare case report and literature review 老年女性左侧闭孔疝伴肠梗阻：一例罕见病例报告及文献复习

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-27 DOI: 10.1016/j.ijscr.2025.112110

Surya Raj Nishad , Alisha Kusatha , Bijaya Paudel , Raju Jayshwal , Sushil Mishra , Binod Bade Shrestha

Introduction and importance

Obturator hernia (OH) is a rare, potentially fatal cause of small bowel obstruction, mainly affecting elderly, thin females. Diagnosis is often delayed due to nonspecific symptoms, causing high morbidity and mortality. Left-sided OH is uncommon because of sigmoid colon protection. We present a left sided OH case managed with a novel appendiceal orifice decompression technique.

Case presentation

An 80-year-old cachectic female (BMI 18 kg/m²) had five days of obstipation, bilious vomiting, abdominal distension, and pain. Clinical examination and abdominal radiographs suggested small bowel obstruction. Contrast-enhanced CT revealed a left obturator hernia containing ileal loops with dilated proximal bowel. Emergency laparotomy confirmed an 11.7 × 10.9 × 7.2 mm left obturator canal defect containing viable ileal loops. Herniated bowel was reduced, followed by appendectomy. Small bowel was decompressed via the appendiceal orifice, avoiding enterotomy. The defect was repaired with preperitoneal polypropylene mesh. The patient recovered uneventfully and was discharged on postoperative day 7, remaining asymptomatic at six months.

Clinical discussion

OH, often presents with vague symptoms, complicating diagnosis. CT is the imaging modality of choice. Left-sided OH is rare. Appendiceal orifice decompression offers a bowel-conserving option in selected frail patients with a healthy appendix. Risks include stump leak and infection. Evidence is limited, requiring further studies for standardization.

Conclusion

Early CT diagnosis and individualized surgical management are crucial. Appendiceal orifice decompression may be considered in high-risk patients, though further evidence is needed to define indications and safety.

简介及重要性闭孔疝（OH）是一种罕见的、可能致命的小肠梗阻原因，主要影响老年人、瘦弱的女性。诊断常常因非特异性症状而延迟，造成高发病率和死亡率。由于乙状结肠的保护，左侧OH并不常见。我们提出了一种新的阑尾孔减压技术处理左侧OH病例。病例介绍：一名80岁的恶病质女性（体重指数18 kg/m2），有5天的排便、胆汁性呕吐、腹胀和疼痛。临床检查及腹部x线片提示小肠梗阻。增强CT显示左闭孔疝包含回肠袢并近端肠扩张。急诊剖腹手术证实左闭孔缺损11.7 × 10.9 × 7.2 mm，含可行回肠袢。切除肠疝，随后行阑尾切除术。小肠经阑尾口减压，避免肠切开术。采用腹膜前聚丙烯补片修复。患者顺利恢复，术后第7天出院，6个月无症状。临床讨论：oh，常表现为症状模糊，使诊断复杂化。CT是首选的成像方式。左侧OH很少见。阑尾口减压为阑尾健康的虚弱患者提供了保肠的选择。风险包括残肢泄漏和感染。证据有限，需要进一步的标准化研究。结论早期CT诊断和个体化手术治疗至关重要。高风险患者可以考虑阑尾口减压，但需要进一步的证据来确定适应症和安全性。

{"title":"Left-sided obturator hernia presenting with bowel obstruction in an elderly female: A rare case report and literature review","authors":"Surya Raj Nishad , Alisha Kusatha , Bijaya Paudel , Raju Jayshwal , Sushil Mishra , Binod Bade Shrestha","doi":"10.1016/j.ijscr.2025.112110","DOIUrl":"10.1016/j.ijscr.2025.112110","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Obturator hernia (OH) is a rare, potentially fatal cause of small bowel obstruction, mainly affecting elderly, thin females. Diagnosis is often delayed due to nonspecific symptoms, causing high morbidity and mortality. Left-sided OH is uncommon because of sigmoid colon protection. We present a left sided OH case managed with a novel appendiceal orifice decompression technique.</div></div><div><h3>Case presentation</h3><div>An 80-year-old cachectic female (BMI 18 kg/m<sup>2</sup>) had five days of obstipation, bilious vomiting, abdominal distension, and pain. Clinical examination and abdominal radiographs suggested small bowel obstruction. Contrast-enhanced CT revealed a left obturator hernia containing ileal loops with dilated proximal bowel. Emergency laparotomy confirmed an 11.7 × 10.9 × 7.2 mm left obturator canal defect containing viable ileal loops. Herniated bowel was reduced, followed by appendectomy. Small bowel was decompressed via the appendiceal orifice, avoiding enterotomy. The defect was repaired with preperitoneal polypropylene mesh. The patient recovered uneventfully and was discharged on postoperative day 7, remaining asymptomatic at six months.</div></div><div><h3>Clinical discussion</h3><div>OH, often presents with vague symptoms, complicating diagnosis. CT is the imaging modality of choice. Left-sided OH is rare. Appendiceal orifice decompression offers a bowel-conserving option in selected frail patients with a healthy appendix. Risks include stump leak and infection. Evidence is limited, requiring further studies for standardization.</div></div><div><h3>Conclusion</h3><div>Early CT diagnosis and individualized surgical management are crucial. Appendiceal orifice decompression may be considered in high-risk patients, though further evidence is needed to define indications and safety.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"137 ","pages":"Article 112110"},"PeriodicalIF":0.7,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Conservative and surgical management of small bowel diverticulitis complicated by enteroliths: A case report 小肠憩室炎合并小肠结石的保守与手术治疗1例

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-27 DOI: 10.1016/j.ijscr.2025.112114

Richard Lee , Jill Jozefowicz , Theodore Niemann

Introduction

Small bowel diverticulitis with enterolith-associated small bowel obstruction is a rare complication which can lead to significant morbidity and mortality. Here we present a case of small bowel diverticulitis which underwent successful conservative management at the time of initial presentation but required a surgical intervention for enterolith-associated small bowel obstruction during a subsequent hospitalization.

Case presentation

We report the case of a 73-year-old female who presented with a small bowel diverticulitis and incidental discovery of an associated enterolith on contrast-enhanced computed tomography (CT). Patient responded well to nonoperative management with antibiotic therapy during the initial hospitalization. However, patient had short interval readmission due to small bowel obstruction secondary to the previously identified enterolith. Emergent surgical intervention was performed with extraction of an enterolith measuring 3 × 3 × 1.5 cm. The postoperative course was uneventful with immediate return of bowel function.

Discussion

Small bowel diverticulitis with enterolith-associated small bowel obstruction has been reported as a rare complication of small bowel diverticulosis. Obstructive symptoms caused by enteroliths >2.5 cm is less likely to self-resolve with nonoperative management. Prompt surgical intervention with enterolith extraction via simple enterotomy is a safe and effective approach to prevent further complications and avoidable hospital stay.

Conclusion

In patients presenting with enterolith-associated small bowel obstruction, prompt evaluation and diagnosis with contrast-enhanced CT is recommended. Large enteroliths causing obstructive symptoms should be addressed with surgical intervention.

小肠憩室炎合并肠石相关性小肠梗阻是一种罕见的并发症，可导致显著的发病率和死亡率。在这里，我们提出一个小肠憩室炎的病例，在最初的表现时进行了成功的保守治疗，但在随后的住院期间需要手术治疗肠结石相关的小肠梗阻。我们报告一个73岁的女性病例，她表现为小肠憩室炎，并在对比增强计算机断层扫描（CT）上偶然发现相关的肠石。在最初住院期间，患者对非手术治疗和抗生素治疗反应良好。然而，由于先前确定的肠石继发的小肠梗阻，患者有短间隔再入院。采用紧急手术干预，取出尺寸为3 × 3 × 1.5 cm的肠石。术后过程顺利，肠功能立即恢复。小肠憩室炎合并肠石相关性小肠梗阻已被报道为小肠憩室病的罕见并发症。2.5 cm肠结石引起的梗阻性症状不太可能通过非手术治疗自行消退。通过简单的肠切开术及时进行手术干预并取出肠石是一种安全有效的方法，可以防止进一步的并发症和避免住院。结论对小肠结石相关性小肠梗阻患者，建议及时进行CT增强检查和诊断。引起梗阻性症状的大肠结石应通过手术治疗。

{"title":"Conservative and surgical management of small bowel diverticulitis complicated by enteroliths: A case report","authors":"Richard Lee , Jill Jozefowicz , Theodore Niemann","doi":"10.1016/j.ijscr.2025.112114","DOIUrl":"10.1016/j.ijscr.2025.112114","url":null,"abstract":"<div><h3>Introduction</h3><div>Small bowel diverticulitis with enterolith-associated small bowel obstruction is a rare complication which can lead to significant morbidity and mortality. Here we present a case of small bowel diverticulitis which underwent successful conservative management at the time of initial presentation but required a surgical intervention for enterolith-associated small bowel obstruction during a subsequent hospitalization.</div></div><div><h3>Case presentation</h3><div>We report the case of a 73-year-old female who presented with a small bowel diverticulitis and incidental discovery of an associated enterolith on contrast-enhanced computed tomography (CT). Patient responded well to nonoperative management with antibiotic therapy during the initial hospitalization. However, patient had short interval readmission due to small bowel obstruction secondary to the previously identified enterolith. Emergent surgical intervention was performed with extraction of an enterolith measuring 3 × 3 × 1.5 cm. The postoperative course was uneventful with immediate return of bowel function.</div></div><div><h3>Discussion</h3><div>Small bowel diverticulitis with enterolith-associated small bowel obstruction has been reported as a rare complication of small bowel diverticulosis. Obstructive symptoms caused by enteroliths >2.5 cm is less likely to self-resolve with nonoperative management. Prompt surgical intervention with enterolith extraction via simple enterotomy is a safe and effective approach to prevent further complications and avoidable hospital stay.</div></div><div><h3>Conclusion</h3><div>In patients presenting with enterolith-associated small bowel obstruction, prompt evaluation and diagnosis with contrast-enhanced CT is recommended. Large enteroliths causing obstructive symptoms should be addressed with surgical intervention.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"137 ","pages":"Article 112114"},"PeriodicalIF":0.7,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Superficial plantar foreign body mimicking plantar fasciitis: A case report 浅表足底异物模拟足底筋膜炎1例

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-27 DOI: 10.1016/j.ijscr.2025.112128

Huabin Chen , Feng Zhang

Introduction

Penetrating foot injuries often involve retained foreign bodies (FBs), Although deep retained FBs are well recognized, superficial metallic FBs embedded specifically within the stratum corneum and mimicking plantar fasciitis are rarely reported and can be easily misdiagnosed.

Case presentation

A 55-year-old male physician experienced 2 weeks of left plantar pain during activity, self-diagnosed as plantar fasciitis，never had a medical check-up at the hospital. Due to the patient's own professional sensitivity as a doctor，a 1 mm black spot was noted on examination by himself，he decided to use a needle to prick this spot. A 2 mm stainless steel fragment was removed from the this black spot of stratum corneum, with immediate pain resolution.

Clinical discussion

Superficial FBs embedded in thick plantar stratum corneum may avoid detection while causing weight-bearing significant weight-bearing pain due to dermal compression. This case highlights FB retention as a critical differential diagnosis for plantar pain, particularly post-trauma. The initial misdiagnosis occurred due to symptom similarity and the patient's prior experience; it underscores the importance of meticulous history and physical examination focusing on potential entry points or subtle skin changes, even if there is no significant history of foreign body punctures. It emphasizes the importance of a meticulous medical history and meticulous physical examination, and timely visits to a clinical specialist for chronic plantar pain.

Conclusion

Plantar FB retention, including within the superficial stratum corneum, should be considered early in the differential diagnosis of unexplained foot pain, especially after potential penetrating injury. Thorough physical examination and history are paramount for diagnosis. This case highlights the importance of considering superficial retained foreign bodies in patients presenting with chronic plantar pain.

导读：穿透性足部损伤通常包括异物残留（FBs），尽管深部异物残留很容易被识别，但浅表金属异物嵌入角质层并模仿足底筋膜炎很少被报道，并且很容易误诊。病例介绍一名55岁男医师，活动时左足底疼痛2周，自诊断为足底筋膜炎，未到医院检查。由于患者自身作为医生的专业敏感性，在检查时发现一个1毫米的黑点，他决定用针扎这个黑点。从角质层黑点处取出2mm不锈钢碎片，疼痛立即缓解。临床讨论浅表FBs嵌埋于厚的足底角质层中，可避免被发现，同时由于皮肤压迫引起明显的负重疼痛。本病例强调FB保留是足底疼痛的重要鉴别诊断，尤其是创伤后足底疼痛。最初的误诊是由于症状相似和患者既往经验所致；它强调了细致的病史和体格检查的重要性，重点是潜在的进入点或细微的皮肤变化，即使没有明显的异物穿刺史。它强调了细致的病史和细致的体格检查以及及时就诊临床专家对慢性足底疼痛的重要性。结论足底FB潴留，包括角质层内，在不明原因足部疼痛的鉴别诊断中应及早考虑，特别是在潜在的穿透性损伤后。全面的体格检查和病史对诊断至关重要。本病例强调了慢性足底疼痛患者考虑体表异物残留的重要性。

{"title":"Superficial plantar foreign body mimicking plantar fasciitis: A case report","authors":"Huabin Chen , Feng Zhang","doi":"10.1016/j.ijscr.2025.112128","DOIUrl":"10.1016/j.ijscr.2025.112128","url":null,"abstract":"<div><h3>Introduction</h3><div>Penetrating foot injuries often involve retained foreign bodies (FBs), Although deep retained FBs are well recognized, superficial metallic FBs embedded specifically within the stratum corneum and mimicking plantar fasciitis are rarely reported and can be easily misdiagnosed.</div></div><div><h3>Case presentation</h3><div>A 55-year-old male physician experienced 2 weeks of left plantar pain during activity, self-diagnosed as plantar fasciitis，never had a medical check-up at the hospital. Due to the patient's own professional sensitivity as a doctor，a 1 mm black spot was noted on examination by himself，he decided to use a needle to prick this spot. A 2 mm stainless steel fragment was removed from the this black spot of stratum corneum, with immediate pain resolution.</div></div><div><h3>Clinical discussion</h3><div>Superficial FBs embedded in thick plantar stratum corneum may avoid detection while causing weight-bearing significant weight-bearing pain due to dermal compression. This case highlights FB retention as a critical differential diagnosis for plantar pain, particularly post-trauma. The initial misdiagnosis occurred due to symptom similarity and the patient's prior experience; it underscores the importance of meticulous history and physical examination focusing on potential entry points or subtle skin changes, even if there is no significant history of foreign body punctures. It emphasizes the importance of a meticulous medical history and meticulous physical examination, and timely visits to a clinical specialist for chronic plantar pain.</div></div><div><h3>Conclusion</h3><div>Plantar FB retention, including within the superficial stratum corneum, should be considered early in the differential diagnosis of unexplained foot pain, especially after potential penetrating injury. Thorough physical examination and history are paramount for diagnosis. This case highlights the importance of considering superficial retained foreign bodies in patients presenting with chronic plantar pain.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"137 ","pages":"Article 112128"},"PeriodicalIF":0.7,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Extraspinal sacrococcygeal anaplastic ependymoma: A case report 棘外骶尾骨间变性室管膜瘤1例

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-27 DOI: 10.1016/j.ijscr.2025.112129

Medhioub Fatma, Tounsi Mohamed Karim, Chamakhi Amine, Baraket Oussama, Triki Wissem, Bouchoucha Sami

Introduction and importance

Ependymomas are glial tumors typically located in the central nervous system. Extraspinal ependymomas, which occur outside the CNS, are exceedingly rare and present significant diagnostic challenges. These tumors most commonly arise in the sacrococcygeal region, often being misdiagnosed as benign or malignant soft tissue masses.

Case presentation

A case of an extraspinal sacrococcygeal subcutaneous ependymoma in a young female adult is presented, highlighting the importance of imaging, histological examination, and complete surgical resection in the management of such tumors.

Clinical discussion

Extraspinal ependymomas are classified into three histological grades, with Grade 3 (anaplastic) ependymomas being more aggressive and associated with a higher risk of metastasis. Although complete surgical excision is the primary treatment, adjuvant radiotherapy may be required for high-grade tumors or incomplete resections.

Conclusions

Extraspinal ependymoma is a rare, potentially malignant tumor that may mimick benign subcutaneous masses, leading to delayed diagnosis. Preoperative MRI is essential for surgical planning and achieving complete resection, which is key for curative treatment. Long-term follow-up is recommended given to the risk of late recurrence and metastases, especially in high-grade forms.

室管膜瘤是一种神经胶质肿瘤，通常位于中枢神经系统。椎管外室管膜瘤，发生在中枢神经系统外，是非常罕见的，并提出了重大的诊断挑战。这些肿瘤最常见于骶尾骨区域，常被误诊为良性或恶性软组织肿块。病例介绍一例年轻女性成人骶尾骨椎管外皮下室管膜瘤，强调了影像学、组织学检查和完全手术切除在治疗此类肿瘤中的重要性。临床讨论：椎管外室管膜瘤可分为三个组织学级别，其中3级（间变性）室管膜瘤更具侵袭性，转移风险更高。虽然完全手术切除是主要的治疗方法，但对于高度肿瘤或不完全切除可能需要辅助放疗。结论椎管间膜瘤是一种罕见的潜在恶性肿瘤，可能与良性皮下肿块相似，导致诊断延误。术前MRI对手术计划和完全切除至关重要，是治疗的关键。考虑到晚期复发和转移的风险，建议长期随访，特别是在高级别形式。

{"title":"Extraspinal sacrococcygeal anaplastic ependymoma: A case report","authors":"Medhioub Fatma, Tounsi Mohamed Karim, Chamakhi Amine, Baraket Oussama, Triki Wissem, Bouchoucha Sami","doi":"10.1016/j.ijscr.2025.112129","DOIUrl":"10.1016/j.ijscr.2025.112129","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Ependymomas are glial tumors typically located in the central nervous system. Extraspinal ependymomas, which occur outside the CNS, are exceedingly rare and present significant diagnostic challenges. These tumors most commonly arise in the sacrococcygeal region, often being misdiagnosed as benign or malignant soft tissue masses.</div></div><div><h3>Case presentation</h3><div>A case of an extraspinal sacrococcygeal subcutaneous ependymoma in a young female adult is presented, highlighting the importance of imaging, histological examination, and complete surgical resection in the management of such tumors.</div></div><div><h3>Clinical discussion</h3><div>Extraspinal ependymomas are classified into three histological grades, with Grade 3 (anaplastic) ependymomas being more aggressive and associated with a higher risk of metastasis. Although complete surgical excision is the primary treatment, adjuvant radiotherapy may be required for high-grade tumors or incomplete resections.</div></div><div><h3>Conclusions</h3><div>Extraspinal ependymoma is a rare, potentially malignant tumor that may mimick benign subcutaneous masses, leading to delayed diagnosis. Preoperative MRI is essential for surgical planning and achieving complete resection, which is key for curative treatment. Long-term follow-up is recommended given to the risk of late recurrence and metastases, especially in high-grade forms.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"137 ","pages":"Article 112129"},"PeriodicalIF":0.7,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Giant splenic artery aneurysm: A case report 脾巨动脉瘤1例

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-27 DOI: 10.1016/j.ijscr.2025.112126

Visagan Srimurugathas , Vinojan Satchithanantham , Mathievanan Sivalingam , Sriluxayini Mayorathan , Mayuran Murugavel , Umashankar Kanthasamy

Introduction

Giant splenic artery aneurysm is a rare entity but can be potentially life threatening if ruptured.

Presentation of case

This case report describes a 77-year-old male with a giant splenic artery aneurysm (12x11x9.7 cm), presenting with persistent left hypochondrial discomfort. The patient underwent open aneurysmectomy and splenectomy. The patient's recovery was uneventful, highlighting surgical management's importance in complex cases.

Discussion

The treatment for splenic artery aneurysm can be open surgical or endovascular based on the size, morphology, the available expertise and the fitness of the patient. Endovascular therapy is less invasive and low morbidity with high success rate.

Conclusion

Open surgical repair with or without splenectomy is a successful treatment modality for giant splenic artery aneurysm.

巨大脾动脉瘤是一种罕见的疾病，但一旦破裂可能危及生命。本病例报告描述了一名77岁男性，患有巨大脾动脉瘤（12x11x9.7 cm），表现为持续的左侧疑病症不适。患者行开放性动脉瘤切除术和脾切除术。患者的恢复是平稳的，突出手术管理的重要性，在复杂的情况下。脾动脉瘤的治疗可根据其大小、形态、可获得的专业技术和患者的健康状况选择手术或血管内治疗。血管内治疗创伤小，发病率低，成功率高。结论脾切除术或不脾切除术是治疗巨脾动脉瘤的有效方法。

引用次数: 0

A unique challenge overcome: Clay foreign body extracted from the bladder endoscopically; A case report 克服了一个独特的挑战：内窥镜下从膀胱中取出粘土异物；病例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-27 DOI: 10.1016/j.ijscr.2025.112118

Faisal Altwijri , Basmah Al Ghanim , Moataz Altokhais , Ali Alyami , Danny Rabah

Introduction

Urethral foreign bodies are uncommon clinical entities typically associated with psychiatric disorders or self-erotic stimulation. They present unique challenges, especially when involving malleable materials.

Case presentation

A 26-year-old male presented with urinary retention and brown urethral discharge after inserting an 8 cm clay-like foreign body. Cystoscopy revealed migration to the bladder. Initial bedside flexible cystoscopy under local anesthesia removed 40 % of the material using a 4.5 mm basket. Complete extraction was achieved in the operating room using a 17 Fr rigid cystoscope under general anesthesia. The patient received prophylactic antibiotics and was discharged uneventfully with oral antibiotics and analgesics.

Discussion

Management of urethral foreign bodies requires consideration of object composition and location. In this case, the malleable clay-like material presented unique challenges but was successfully managed using endoscopic fragmentation techniques. This avoided more invasive open surgical intervention while effectively addressing the clinical presentation. Literature documents various foreign objects in the urethra, but clay-like materials are less commonly reported and present specific challenges due to their malleable nature and fragmentation potential.

Conclusion

Prompt endoscopic intervention can successfully manage even challenging cases of migrated urethral foreign bodies. A multidisciplinary approach addressing both physical and psychological aspects is essential for comprehensive care and prevention of recurrence.

尿道异物是一种罕见的临床实体，通常与精神障碍或自我性刺激有关。他们提出了独特的挑战，特别是当涉及延展性材料时。病例介绍：一名26岁男性，在插入8厘米粘土样异物后出现尿潴留和棕色尿道分泌物。膀胱镜检查显示向膀胱迁移。在局部麻醉下，最初的床边柔性膀胱镜检查使用4.5 mm的筐去除40%的物质。在全麻下，在手术室用17fr硬膀胱镜完成了完全的取出。患者接受预防性抗生素治疗，并在口服抗生素和止痛药治疗后顺利出院。尿道异物的处理需要考虑异物的组成和位置。在这种情况下，可塑粘土状材料面临着独特的挑战，但通过内窥镜破碎技术成功地进行了处理。这避免了更多的侵入性开放手术干预，同时有效地解决了临床表现。文献记载了尿道中的各种异物，但粘土状物质较少报道，并且由于其延展性和碎裂潜力而面临特殊挑战。结论及时的内镜介入治疗可成功治疗尿道异物移位。多学科的方法处理生理和心理方面是必要的综合护理和预防复发。

{"title":"A unique challenge overcome: Clay foreign body extracted from the bladder endoscopically; A case report","authors":"Faisal Altwijri , Basmah Al Ghanim , Moataz Altokhais , Ali Alyami , Danny Rabah","doi":"10.1016/j.ijscr.2025.112118","DOIUrl":"10.1016/j.ijscr.2025.112118","url":null,"abstract":"<div><h3>Introduction</h3><div>Urethral foreign bodies are uncommon clinical entities typically associated with psychiatric disorders or self-erotic stimulation. They present unique challenges, especially when involving malleable materials.</div></div><div><h3>Case presentation</h3><div>A 26-year-old male presented with urinary retention and brown urethral discharge after inserting an 8 cm clay-like foreign body. Cystoscopy revealed migration to the bladder. Initial bedside flexible cystoscopy under local anesthesia removed 40 % of the material using a 4.5 mm basket. Complete extraction was achieved in the operating room using a 17 Fr rigid cystoscope under general anesthesia. The patient received prophylactic antibiotics and was discharged uneventfully with oral antibiotics and analgesics.</div></div><div><h3>Discussion</h3><div>Management of urethral foreign bodies requires consideration of object composition and location. In this case, the malleable clay-like material presented unique challenges but was successfully managed using endoscopic fragmentation techniques. This avoided more invasive open surgical intervention while effectively addressing the clinical presentation. Literature documents various foreign objects in the urethra, but clay-like materials are less commonly reported and present specific challenges due to their malleable nature and fragmentation potential.</div></div><div><h3>Conclusion</h3><div>Prompt endoscopic intervention can successfully manage even challenging cases of migrated urethral foreign bodies. A multidisciplinary approach addressing both physical and psychological aspects is essential for comprehensive care and prevention of recurrence.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"137 ","pages":"Article 112118"},"PeriodicalIF":0.7,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case report of complete penoscrotal transposition and associated anomalies in a newborn 新生儿完全性阴囊转位及相关异常1例

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-27 DOI: 10.1016/j.ijscr.2025.112113

Nyamhanga Maro Nsaho , Donald Dominick Lema , Bartholomeo Nicholaus Ngowi , Denis Mucunguzi , Orgeness Jasper Mbwambo , Janneth Mpelumbe

Introduction

Penoscrotal transposition is a rare congenital abnormality in which the scrotum is positioned above the penis. It results from the disrupted development of the genital tubercle and labioscrotal folds. The exact embryological errors are not fully understood, but they may arise from a failure in their migration and fusion around 12 weeks of gestation.

Case presentation

A term male newborn was referred 4 h after birth due to respiratory distress, abnormal genitalia, and failure to pass meconium or urine. He had pulmonary hypertension, early-onset neonatal sepsis, complete penoscrotal transposition, and possibly an anorectal malformation. Evaluation showed elevated creatinine, hyperkalaemia, leucocytosis, and severe pulmonary hypertension. Despite supportive care—including antibiotics, fluids, correction of hyperkalaemia, and sildenafil—he deteriorated and died before surgery. The final diagnosis was a complex congenital anomaly, sepsis, and multiorgan failure leading to death.

Clinical discussion

Persistent scrotal transposition is associated with midline defects, including anorectal, cardiac, and gonadal anomalies. Early prenatal imaging and thorough postnatal assessments—such as echocardiography, renal imaging, and genetic testing—are essential. The complexity of this anomaly requires organised, multidisciplinary management. By focusing on key investigations and prompt interventions, even with limited resources, outcomes can be enhanced and future diagnostic and prognostic strategies improved.

Conclusion

A rare complete penoscrotal transposition with multiple anomalies and sepsis highlights the importance of multidisciplinary care and enhanced antenatal screening.

阴囊转位是一种罕见的先天性异常，其阴囊位于阴茎上方。它是由生殖器结节和阴唇沟发育中断引起的。确切的胚胎学错误尚不完全清楚，但它们可能是由于妊娠12周左右的迁移和融合失败而引起的。病例介绍1例足月男婴，因呼吸窘迫、生殖器异常、粪尿不清，于出生后4小时就诊。他有肺动脉高压，早发性新生儿败血症，完全性阴囊转位，可能还有肛门直肠畸形。评估显示肌酐升高、高钾血症、白细胞增多和严重的肺动脉高压。尽管有支持性护理——包括抗生素、液体、纠正高钾血症和西地那非——他的病情恶化并在手术前死亡。最后的诊断是复杂的先天性异常、败血症和导致死亡的多器官衰竭。临床讨论：持续性阴囊移位与中线缺陷有关，包括肛肠、心脏和性腺异常。早期产前成像和彻底的产后评估——如超声心动图、肾脏成像和基因检测——是必不可少的。这种异常现象的复杂性需要有组织的、多学科的管理。即使在资源有限的情况下，通过重点调查和及时干预，也可以提高结果，改善未来的诊断和预后策略。结论一例罕见的完全性阴囊转位合并多处异常和脓毒症突出了多学科护理和加强产前筛查的重要性。

{"title":"A case report of complete penoscrotal transposition and associated anomalies in a newborn","authors":"Nyamhanga Maro Nsaho , Donald Dominick Lema , Bartholomeo Nicholaus Ngowi , Denis Mucunguzi , Orgeness Jasper Mbwambo , Janneth Mpelumbe","doi":"10.1016/j.ijscr.2025.112113","DOIUrl":"10.1016/j.ijscr.2025.112113","url":null,"abstract":"<div><h3>Introduction</h3><div>Penoscrotal transposition is a rare congenital abnormality in which the scrotum is positioned above the penis. It results from the disrupted development of the genital tubercle and labioscrotal folds. The exact embryological errors are not fully understood, but they may arise from a failure in their migration and fusion around 12 weeks of gestation.</div></div><div><h3>Case presentation</h3><div>A term male newborn was referred 4 h after birth due to respiratory distress, abnormal genitalia, and failure to pass meconium or urine. He had pulmonary hypertension, early-onset neonatal sepsis, complete penoscrotal transposition, and possibly an anorectal malformation. Evaluation showed elevated creatinine, hyperkalaemia, leucocytosis, and severe pulmonary hypertension. Despite supportive care—including antibiotics, fluids, correction of hyperkalaemia, and sildenafil—he deteriorated and died before surgery. The final diagnosis was a complex congenital anomaly, sepsis, and multiorgan failure leading to death.</div></div><div><h3>Clinical discussion</h3><div>Persistent scrotal transposition is associated with midline defects, including anorectal, cardiac, and gonadal anomalies. Early prenatal imaging and thorough postnatal assessments—such as echocardiography, renal imaging, and genetic testing—are essential. The complexity of this anomaly requires organised, multidisciplinary management. By focusing on key investigations and prompt interventions, even with limited resources, outcomes can be enhanced and future diagnostic and prognostic strategies improved.</div></div><div><h3>Conclusion</h3><div>A rare complete penoscrotal transposition with multiple anomalies and sepsis highlights the importance of multidisciplinary care and enhanced antenatal screening.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"137 ","pages":"Article 112113"},"PeriodicalIF":0.7,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cauda equina syndrome due to lumbar disc herniation managed with unilateral biportal endoscopic discectomy: A case report and review of literature 单侧双门静脉内窥镜椎间盘切除术治疗腰椎间盘突出引起的马尾综合征：一例报告和文献回顾

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-27 DOI: 10.1016/j.ijscr.2025.112115

Prakrit Chhetri , Bishnu Babu Thapa , Amir Ratna Shakya , Bimal Rai

Introduction and importance

Cauda equina syndrome is a rare spinal emergency due to compression of the cauda equina nerve roots which present with bladder and/or bowel dysfunction, saddle anesthesia, and sexual dysfunction with or without a neurological deficit in the lower limbs and requires urgent surgical decompression through open methods or new minimally invasive procedures like Unilateral Biportal Endoscopic Discectomy.

Case presentation

A 38-year-old serving army personnel presented with history of urinary incontinence, constipation and paresthesia of left lower limb for 1 week, which was preceded by low backache for 2 months. Although the motor examination of L2-S1 nerves was intact, the perianal sensation was impaired with lax anal tone and absent bulbocavernosus reflex. After the confirmation of complete cauda equina syndrome clinically, supported by MRI of Lumbosacral spine with disc extrusion at L5-S1compressing on bilateral traversing S1 nerve roots as the cause, the patient underwent decompression surgery through unilateral biportal endoscopic method with almost complete recovery post-surgery.

Clinical discussion

Cauda equina syndrome when diagnosed has been advised to undergo surgical decompression ideally within 48 h. The decompression can be done by open methods or minimally invasive methods. The minimally invasive endoscopic methods have been found to have better outcomes.

Conclusion

Cauda equina syndrome, being an emergency with potentially devastating outcomes, require surgical decompression and presently minimally invasive techniques like Unilateral Biportal Endoscopy (UBE) are being popular due to decreased procedure related patient morbidity and quicker recovery.

马尾神经综合征是一种罕见的脊柱急症，由于马尾神经根受压，表现为膀胱和/或肠道功能障碍，鞍区麻醉，性功能障碍，伴或不伴下肢神经功能障碍，需要紧急手术减压，通过开放方法或新的微创手术，如单侧双门静脉内窥镜椎间盘切除术。一例38岁现役军人，尿失禁、便秘、左下肢感觉异常病史1周，前腰痛2个月。虽然L2-S1神经的运动检查完好，但肛门周围感觉受损，肛门张力松弛，球海绵体反射缺失。临床确诊为完全性马尾综合征后，经腰骶椎MRI证实，病因为l5 -S1椎间盘突出压迫双侧穿越S1神经根，患者行单侧双门静脉内镜减压手术，术后几乎完全恢复。临床讨论马尾综合征确诊后应在48小时内行手术减压，减压可采用开放方法或微创方法。微创内镜方法已被发现有更好的结果。结论马尾综合征是一种具有潜在破坏性后果的急症，需要手术减压，目前微创技术如单侧双门静脉内窥镜（UBE）正受到欢迎，因为手术相关的患者发病率降低，恢复速度更快。

{"title":"Cauda equina syndrome due to lumbar disc herniation managed with unilateral biportal endoscopic discectomy: A case report and review of literature","authors":"Prakrit Chhetri , Bishnu Babu Thapa , Amir Ratna Shakya , Bimal Rai","doi":"10.1016/j.ijscr.2025.112115","DOIUrl":"10.1016/j.ijscr.2025.112115","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Cauda equina syndrome is a rare spinal emergency due to compression of the cauda equina nerve roots which present with bladder and/or bowel dysfunction, saddle anesthesia, and sexual dysfunction with or without a neurological deficit in the lower limbs and requires urgent surgical decompression through open methods or new minimally invasive procedures like Unilateral Biportal Endoscopic Discectomy.</div></div><div><h3>Case presentation</h3><div>A 38-year-old serving army personnel presented with history of urinary incontinence, constipation and paresthesia of left lower limb for 1 week, which was preceded by low backache for 2 months. Although the motor examination of L2-S1 nerves was intact, the perianal sensation was impaired with lax anal tone and absent bulbocavernosus reflex. After the confirmation of complete cauda equina syndrome clinically, supported by MRI of Lumbosacral spine with disc extrusion at L5-S1compressing on bilateral traversing S1 nerve roots as the cause, the patient underwent decompression surgery through unilateral biportal endoscopic method with almost complete recovery post-surgery.</div></div><div><h3>Clinical discussion</h3><div>Cauda equina syndrome when diagnosed has been advised to undergo surgical decompression ideally within 48 h. The decompression can be done by open methods or minimally invasive methods. The minimally invasive endoscopic methods have been found to have better outcomes.</div></div><div><h3>Conclusion</h3><div>Cauda equina syndrome, being an emergency with potentially devastating outcomes, require surgical decompression and presently minimally invasive techniques like Unilateral Biportal Endoscopy (UBE) are being popular due to decreased procedure related patient morbidity and quicker recovery.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"137 ","pages":"Article 112115"},"PeriodicalIF":0.7,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0