International Journal of Surgery Case Reports最新文献

Introduction: Hernia repair is a common procedure performed by general surgeons. Introduced in 1990s, the use of laparoscopic hernia repair has recently increased and, consequently, rare complications previously unknown have been reported.

Presentation of case: A 43-years-old male patient who underwent a transabdominal preperitoneal patch plasty (TAPP) procedure for symptomatic bilateral inguinal hernia. On the sixth postoperative day, the patient was admitted for small bowel obstruction (SBO) and underwent reoperation; the central portion of the peritoneal suture in the left inguinal region was lacerated and a hole in the peritoneum had performed a hernia orifice, causing small bowel occlusion by preperitoneal herniation. After the hernia was released, the peritoneum was closed again and the surgery was completed.

Discussion: SBO after TAPP procedure is a rare complication and should be considered in patients with abdominal pain and vomiting after TAPP procedure.

Conclusion: This complication can be prevented with appropriate peritoneal closure techniques and treated with early laparoscopic surgery.

Introduction: Textiloma, or gossypiboma, is a rare oversight in thoracic surgery involving retained surgical sponges, with the potential for serious complications like chronic pain and infection. This case highlights a 29-year-old woman with a transdiaphragmatic migrated gossypiboma following liver surgery.

Case presentation: A-29 years old woman presented with dyspnea, abdominal pain, and fever, with imaging revealing a suspected hepatic abscess. Surgical intervention identified a 15 cm gossypiboma in the thoracic cavity, previously misdiagnosed, leading to successful extraction and recovery.

Discussion: Gossypibomas can cause significant complications, including abscess formation and respiratory distress, especially when migrating through the diaphragm. Diagnosis is challenging, often requiring advanced imaging techniques to identify the retained foreign body.

Conclusion: This case emphasizes the need for heightened awareness of gossypiboma in patients with unexplained post-surgical symptoms. Early detection and meticulous surgical practices are crucial to prevent serious complications associated with retained foreign bodies.

Introduction and importance: The Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA) is a recently recognized entity characterized by a constellation of nonspecific symptoms that develop after exposure to adjuvants. Adjuvants can include vaccines, silicone, and other foreign substances. Here, we present the case of a 31-year-old woman who developed ASIA syndrome following breast implants and booster vaccinations, emphasizing the diagnostic challenges and treatment considerations.

Case presentation: A 31-year-old female presented with a history of progressive systemic symptoms including chronic fatigue, myalgia, arthralgia, and headaches, four months after receiving breast implants. Her clinical history was further complicated by multiple vaccinations, including influenza and SARS-CoV-2 boosters. After extensive diagnostic workup and unsuccessful medical management, she was diagnosed with ASIA syndrome. The decision was made to remove the implants, leading to rapid and complete resolution of her symptoms.

Clinical discussion: ASIA syndrome is a difficult diagnosis due to its broad symptomatology and its mimicry of other autoimmune and inflammatory conditions. Diagnostic criteria, proposed by Shoenfeld et al., include exposure to adjuvants and the appearance of typical clinical manifestations such as fatigue, myalgias, and arthralgias. In this case, the temporal association with breast implants and vaccinations made the diagnosis more evident. Surgical removal of the implants led to immediate improvement, reinforcing the diagnosis.

Conclusion: This case highlights the importance of recognizing ASIA syndrome as a potential diagnosis in patients with exposure to adjuvants and unexplained systemic symptoms. Early diagnosis and intervention, such as removal of the triggering adjuvant, are essential for patient recovery.

Evidence based medicine ranking: Level IV.

Introduction: Renal leiomyoma is a rare renal tumor that originates from smooth muscle. Among all existing benign renal tumors, leiomyoma is one of the least common benign renal tumors.

Case presentation: We report of a case report of a 43-year-old male complaints of palpable mass on the upper left abdomen, abdominal discomfort and hematuria. Contrast-enhanced CT scan revealed a solid heterogenous mass on the left kidney, adherent to the left abdominal wall and pushed the spleen cranially. Patient underwent radical nephrectomy and histopathology results revealed leiomyoma. Two weeks after surgery, the patient was asymptomatic.

Discussion: Imaging of renal leiomyoma may provide a clue with a general finding of a well-defined tumor margin and no local invasion. In our case preoperative CT findings made the initial diagnosis inconclusive since it showed the renal mass was adherent to the abdominal wall. Definitive diagnosis was only possible through histopathologic examination.

Conclusion: Radical nephrectomy remains as the mainstay of treatment in inconclusive preoperative diagnosis.

Introduction and importance: Uterine leiomyomas, or fibroids, are benign mesenchymal tumors, which represent the most common tumors of the female genital tract. Their occurrence in pediatric and adolescent populations is uncommon, and relatively few cases have been documented in the literature, particularly in lower-resourced settings. This case highlights the importance of recognizing that although uncommon, fibroids can occur in much younger populations. Also highlights the need for healthcare practitioners in resource-limited environments to be vigilant in considering leiomyoma in differential diagnoses, even in younger patients, and to adapt their treatment approach given the constraints of local healthcare systems.

Case presentation: Here we present an uncommon case of uterine leiomyoma in a 16-year-old female from Northern Tanzania. She presented with lower abdominal pain associated with abdominal distension, prolonged menses, headache, and anemia. Transvaginal US and pelvic MRI were performed and revealed an enlarged uterus with a heterogeneous mass in the posterolateral uterine wall. Myomectomy was performed, and post-operative recovery was uneventful. The final histopathological report confirmed the diagnosis of intramural uterine leiomyoma.

Clinical discussion: In this report, we discuss the rarity of this condition, the literature surrounding similar reports, and the many challenges that arise in the management of leiomyoma in a young adolescent population.

Conclusion: Uterine leiomyomas should be considered as a differential diagnosis in pediatric and adolescent females presenting with a pelvic mass and abdominal pain. Though there are no specific guidelines for treatment, management of leiomyomas in this age group, should be conservative and based on symptom severity with the goal of preserving fertility.This case underscores the need for more research and awareness of uterine leiomyomas in adolescents to improve understanding and management of this rare condition in this age group, particularly in regions like Northern Tanzania where access to healthcare may be limited.

Introduction: Dysphagia is a rare initial manifestation of primary hyperparathyroidism, which typically presents with gastrointestinal symptoms like anorexia and constipation. This case presentation aims to describe swallowing difficulty as a potential primary symptom of parathyroid hormone (PTH)-mediated hypercalcemia.

Presentation of case: An elderly Palestinian female presented with a two-year history of progressive dysphagia, along with mood disturbances and increased urination. Her medical history included osteoporosis and hyperparathyroidism. Laboratory tests showed elevated PTH and calcium levels. Imaging, including neck ultrasound (US) and Tc99m sestamibi scan, identified a parathyroid adenoma. Despite normal findings on esophagogastroduodenoscopy, a focused single parathyroidectomy was performed. Post-surgery, the patient's dysphagia resolved completely, and her calcium and PTH levels normalized.

Discussion: This case highlights an atypical presentation of PTH-mediated hypercalcemia where dysphagia was the primary symptom. Literature review shows similar cases where parathyroid adenomas presented with unusual symptoms, emphasizing the need for thorough diagnostic evaluation. The resolution of dysphagia following surgery suggests a likely correlation between hypercalcemia and dysphagia, implying a possible causative association.

Conclusion: This case demonstrates dysphagia as a rare but significant symptom of hypercalcemia in a patient with a small parathyroid adenoma. Considering its size, it was unlikely to cause dysphagia through mechanical obstruction. Thus, a functional cause linked to hypercalcemia was likely to be the cause of dysphagia. Surgical removal of the adenoma resulted in resolution of symptoms. A literature review was performed, which revealed similar cases of dysphagia related to hypercalcemia, supporting the fact that in this patient, dysphagia was related to the hypercalcemia.

Introduction and importance: The aim of this retrospective study was to present six cases of trauma to the distal pancreas, highlighting the challenges associated with their diagnosis and management, while underlining their seriousness and the various complications potentially encountered. Our case series highlights individual patient outcomes, demonstrating the diversity of clinical presentations and the importance of customized treatment strategies.

Case series: Between January 2015 and December 2020, six cases of distal pancreas trauma were identified. In two cases, the diagnosis was made based on emergency abdominal CT scans, while in the other four patients, the diagnosis was made directly intraoperatively, mainly because of the severity of the associated lesions, which necessitated laparotomy for exploration.

Clinical discussion: Out of 115 cases of closed abdominal trauma, injury to the distal pancreas was identified in 6 patients, (5.2 %), with a mean age of 21 years. Despite the use of abdominal CT scans for all patients, pancreatic trauma was directly diagnosed intraoperatively in 4 cases (67 %). All patients presented with concomitant abdominal injuries (100 %), and 3 patients (50 %) exhibited multiple severe injuries. Additionally, a significant elevation in pancreatic serum markers was observed in 3 patients (50 %). The pancreatic injuries predominantly involved the tail of the pancreas (67 %), while the body was affected in one patient, and the isthmus was completely transected in another. Three of our patients developed a pancreatic fistula (50 %) and two patients (33 %) passed away; the first had severe associated lesions, and the second, despite undergoing several iterative laparotomies, succumbed to postoperative complications following a left pancreatectomy.

Conclusion: Closed traumatism of the distal pancreas, although rare, is a significant problem. It is often diagnosed during emergency laparotomy but can sometimes be found on preoperative CT scans. When the patient's condition permits, it is highly advisable to undergo a left pancreatectomy. Simple external drainage is reserved for certain specific situations.

Introduction and importance: Acute internal carotid artery (ICA) thrombosis is a rare complication of mastoiditis, which can spread to intracranial vessels, leading to thrombosis and infarction.

Case presentation: An 83-year-old man presented to the neurologist with progressive left-sided ear swelling and peripheral facial palsy lasting several weeks. Intravenous antibiotic was prescribed for chronic mastoiditis. Sudden consciousness disturbance and right hemiplegia occurred during treatment. Brain magnetic resonance imaging revealed acute ICA occlusion with hemispheric cerebral infarction. Surgical intervention for complicated mastoiditis was planned after the acute phase of the cerebral infarction. However, the patient's condition deteriorated due to sepsis, ultimately leading to death.

Clinical discussion: Mastoiditis may lead to skull base osteomyelitis, which can directly involve the ICA and cause acute thrombosis. In complicated mastoiditis, early surgical intervention may prevent severe complications.

Conclusion: This case highlights mastoiditis as a potential precursor to ICA territory infarction, and delayed aggressive management can result in severe complications.

Introduction and importance: Post-traumatic ectopic nail (PTEN) refers to the abnormal growth of a new nail in a site other than the usual one, typically occurs after a trauma to the nail matrix. The exact pathogenesis is still unknown. This rare condition often affects the dorsal aspect of the phalanx. Surgical excision of the nail is the treatment of choice, with complete destruction of the nail matrix.

Presentation of case: We report a case of an 18-year-old female presenting to the clinic with an asymptomatic keratotic lesion on the lateral aspect of the distal phalanx after 3 years of digit trauma. X-ray imaging of the affected finger was normal, without any bony deformity. The ectopic nail was surgically excised with cauterization of the matrix to prevent relapse.

Clinical discussion: Ectopic nails can be either congenital or acquired. Injuries can lead to PTEN formation by causing the germinal matrix to divide and implant into the skin. The ectopic nail in our case arises from the lateral aspect of the finger 3 years after trauma, which is an unusual occurrence.

Conclusion: The ectopic nail causes an aesthetical concern, usually with no other symptoms. However, surgical excision is necessary, with emphasis on the importance of cauterizing the matrix to prevent future relapse.

Introduction and importance: Temporomandibular joint (TMJ) ankylosis in children severely impacts mouth opening, orofacial growth, airway space, and overall quality of life. While costochondral grafts (CCG) are the gold standard for end-stage TMJ reconstruction in children, their unpredictable growth poses challenges, including potential overgrowth, undergrowth, resorption, and reankylosis. However, recent reports have suggested the feasibility of alloplastic TMJ in pediatric patients. This case represents one of the youngest patients to undergo alloplastic bilateral TMJ reconstruction for end-stage TMJ disease documented in the literature.

Presentation of the case: A 6-year-old child presented with complaints of 4 mm mouth opening, retrognathic mandible, and snoring for three years. Detailed investigations and examinations diagnosed severe OSA secondary to bilateral TMJ ankylosis. A 15 mm bilateral mandibular angle distraction was performed. After a three-month consolidation period, bilateral custom alloplastic TMJ reconstruction was done. Post-surgery, the maximum interincisal opening improved to 21 mm, and the retrognathic mandible was corrected. OSA resolved completely. The 25 mm mouth opening was maintained one year postoperatively with no complications.

Clinical discussion: The primary advantages of alloplastic TMJ prostheses in treating end-stage TMJ disease include improved mouth opening, maintenance of mandibular form and function, enhanced airway space, elimination of donor site morbidity, reduced operating time, decreased risk of reankylosis, facilitation of immediate physiotherapy, avoidance of under- or overgrowth, and restoration of vertical facial dimensions.

Conclusion: Custom alloplastic TMJ reconstruction can be a viable treatment option for end-stage TMJ disease in very young children, including those six years old or younger.