International Journal of Surgery Case Reports最新文献

Introduction: Lipomas are the most common benign mesenchymal tumors, making up 50 % of soft tissue tumors. However, while they frequently occur in areas like the head, neck, shoulders, and back, lipomas in the hands and wrists are rare, particularly in the fingers where they are exceptionally uncommon.

Case presentation: We present a case of 62-year-old female presented with a six-year history of a gradually enlarging, painful swelling on the palmar aspect at the base of her left index finger. Examination revealed a soft, fluctuating, 3 cm × 2 cm swelling. USG and MRI suspected it to be a lipoma. The lesion was excised, and histopathology confirmed a benign lipoma.

Discussion: Lipomas, derived from mesenchymal preadipocytes, often have genetic and metabolic links, including in individuals with obesity, hyperlipidemia, and diabetes. While typically asymptomatic, lipomas in the hands and fingers can cause pain and impairment, necessitating surgical resection. Accurate diagnosis may require imaging, and treatment yields favourable outcomes with low recurrence rates.

Conclusion: Despite their rarity, lipomas in the hands and fingers should be considered when evaluating non-discharging swellings. Surgical resection is the primary treatment.

Introduction and importance: Lymphangiomas are rare benign lymphatic malformations, typically affecting the head, neck, or axillary regions, with abdominal cystic lymphatic malformations (CLM) being particularly uncommon in adults. Abdominal CLM account for less than 5 % of all lymphangiomas and 7 % of all abdominal cystic lesions in adults with a prevalence of approximately 1 in 250,000. These lesions are commonly found by accident during imaging investigations and are asymptomatic. Being free of any attachment, floating in the peritoneal cavity make it unique in its presentation.

Case presentation: We report a case of 25-year-old female who complaining of right upper abdominal pain. Initial laboratory and imaging studies by abdominal computed tomography (CT) scan showed multiple complex cysts with undetermined origin. Exploration laparoscopy was performed, revealing over 50 variable-sized cysts, some of them were floating freely within the abdominal cavity. Complete resection of all cysts was performed. Postoperative recovery was uneventful, and histopathological examination confirmed the diagnosis of cystic lymphangiomas.

Clinical discussion: This case demonstrates the unusual presentation of multiple, floating, and variably sized intra-abdominal cystic lymphangiomas, a rare finding that presents significant diagnostic and management challenges. The absence of attachment to common intra-abdominal structures, such as the mesentery or omentum, further complicates the clinical picture.

Conclusion: Abdominal CLM must be considered as possible diagnosis especially if the cysts are multiple and complex. Freely floating abdominal CLM may cause the symptoms of a moving lump described by the patient, which must be taken in consideration.

Introduction: Retronychia is defined as a condition where the proximal nail plate grows into the proximal nail fold with the formation of multiple layers of nail plates. It relates to frequent microtrauma that affects the toenails, especially the big toe and it is less common on the fingernails.

Case presentation: Case 1: A 14-year-old female presented with nail growth stopped and painful swelling in her left hallux that did not respond to antibiotics. The patient had been traumatized at the same toenail. Retronychia was diagnosed, and nail avulsion was performed. Case 2: An 18-year-old man came with painful swelling and stopped growth in his right great toenail that did not improve with antibiotics. The patient had previously trauma the same toenail. Retronychia was diagnosed clinically, and nail avulsion was performed. Case 3: A 30-years-old woman presented with Inflammation and pain in her right toenail. She mentioned a previous trauma to her foot. Retronychia was diagnosed clinically and she underwent onychectomy.

Discussion: Retronychia is a chronic nail abnormity based on unresolved chronic proximal paronychia caused by disintegrated nail growth and several generations of nail plate localization underneath the damaged nail. The most common reason for retronychia is trauma which also happens after repetitive micro-trauma. Clinical diagnosis is the basis of retronychia. Retronychia treatment varies between surgical treatment and conservative treatment.

Conclusion: This paper highlights the importance of considering retronychia as a potential differential diagnosis in cases of chronic paronychia, and stresses the significance of early detection to prevent complications.

Introduction: Hernia forms when an organ or its fascia protrudes through the continuing cavity's wall. Amyand's hernia describes an inguinal hernia containing an appendix, regardless of inflammation.

Presentation of case: Our patient was complaining of an increasing lump in the inguinal area. It started 5 years ago as a small mass that gradually increased, manifesting distressing symptoms. The initial diagnosis was an indirect right inguinal hernia. During the surgery, the presence of an indirect inguinal hernia was observed, and the appendix was revealed within the sac, with the observation of adhesion of the appendix tip to the sac.

Discussion: Amyand's hernia describes an inguinal hernia, containing the appendix inside it. It is classified according to Losanoff and Basson depending on the presence and spread of inflammation. The diagnosis of Amyand's hernia is often made during the surgery because of its rarity and unspecific symptoms. When symptoms and signs occur, they masquerade as strangulated hernia rather than appendicitis.

Conclusion: Even Amyand's hernia is a rare condition; it should be a differential diagnosis in patients who come with strangulated hernia or appendicitis. More studies are needed to understand the physiology of this type of hernia. In addition, more cases should be reported to help establish guidelines for diagnosing and treating this hernia.

Introduction: Popliteal artery pseudoaneurysm is rare after blunt trauma without associated bone fracture, usually presenting in a delayed fashion. We present a case of early presentation following minor civilian trauma.

Case presentation: A 66-year-old man presented with left leg pain and swelling after a trivial knee hyperextension injury. Ultrasound revealed a popliteal artery pseudoaneurysm, confirmed by CT angiogram. Open surgical repair with interposition graft was successful. Intraoperatively, a 3 cm linear laceration in the retrogenicular popliteal artery and ipsilateral hamstring tear were noted.

Discussion: Delayed presentation is typical, making early detection challenging. Our case emphasizes maintaining suspicion for popliteal artery pseudoaneurysm, especially after trivial knee injuries. Prompt imaging and intervention are crucial to mitigate potential complications.

Conclusion: Popliteal artery pseudoaneurysm from minor knee trauma is rare but should be considered in patients with leg pain and swelling. Early detection and surgical intervention are vital to prevent complications.

Introduction and importance: Tubercular Immune Reconstitution Inflammatory syndrome (TB-IRIS) is defined as the worsening of existing disease or new tuberculosis lesions during anti-tuberculosis therapy after excluding drug resistance, adherence issues, secondary infection, and malignancy. Ventriculitis is a rare and detrimental complication of cerebral tuberculosis. Here, we report a case of ventriculitis as a manifestation of TB-IRIS.

Case presentation: A 46-year-old male presented to the emergency department with a decline in consciousness for four days prior to admission. He experienced a progressive headache accompanied by intermittent high-grade fever over the past week. He was diagnosed with rifampicin-sensitive pulmonary tuberculosis three months prior and was treated with a fixed-dose combination of anti-tuberculosis (ATT) regimen. His HIV test result was negative. A non-contrast computed tomography (CT) scan revealed ventriculitis and hydrocephalus. The patient subsequently received ATT and corticosteroids, along with external ventricular drainage (EVD) to alleviate intracranial pressure and address the intraventricular infection. Regrettably, the patient's condition progressively declined, resulting in his demise on the seventh day post-admission.

Clinical discussion: TB-IRIS is primarily characterized in individuals with HIV/tuberculosis coinfection; however, it does not exclude that TB-IRIS may occur in immunocompetent conditions. Tuberculous ventriculitis is a manifestation of CNS TB-IRIS, characterized by significant morbidity and mortality. The fundamental principle in managing ventriculitis is to control both the inflammation and the infection and reducing intracranial pressure.

Conclusion: This particular case does not significantly enhance the management of CNS-TB-IRIS; however, it does bring attention to the potential occurrence of this condition in immunocompetent patients.

Introduction: Teratomas are germ cell neoplasms arising from the totipotent stem cells. Retroperitoneal teratomas are very rare, accounting for about 5 % of all teratomas of those, primary adrenal ones are exceedingly rare, with few cases reported in the English literature in pediatric age group.

Case presentation: A nine-month-old female presented with a two-month history of gradually increasing abdominal distention, her physical examination revealed a palpable large abdominal mass. Abdominal CT imaging showed a right suprarenal heterogeneous mass. Oncological resection was performed, and histopathology confirmed a primary mature adrenal teratoma.

Discussion: The diagnosis of primary adrenal teratoma is usually challenging and relies predominantly on imaging studies, and histopathological finding.

Conclusion: Primary adrenal teratoma is extremely rare in pediatric age group, and present a significant diagnostic challenge, as a result it should be considered in the differential diagnosis of pediatric patients with adrenal masses.

Introduction: Arteriovenous malformations (AVMs) of facial bones are rare conditions. These lesions can cause aesthetic challenges, pain, impact on gums and teeth, facial asymmetry, and life-threatening bleeding.

Presentation of the case: This report described a case involving the resection of AVMs within the maxilla following preoperative embolization and sclerotherapy by using an ultrasonic bone aspirator (Sonopet®, Stryker, Kalamazoo, MI, USA) and a radiofrequency bipolar sealer (Aquamantys™, Medtronic, Minneapolis, MN, USA). The AVMs and deformed bone were resected en bloc through repeated cutting and hemostasis, preserving the maxillary crown and maintaining the maxillary structure by treating only the affected bone.

Discussion: Reducing inflow during surgery and controlling intraoperative bleeding requires thorough planning. Preoperative embolization and sclerotherapy can reduce inflow to the tumor, and appropriate surgical devices enable the resection of arteriovenous malformations within the maxilla.

Conclusion: The method presented in this report is a viable treatment option because it allows for selective bone removal, thus leading to the preservation of crowns and maxillary contour.

Introduction and importance: Adenoid cystic carcinoma (ACC) is an uncommon malignant tumor with histological features commonly associated with salivary glands. Although it is thought that human papillomavirus infection is a required cause of most cases of cervical cancer, little is known about its function in the pathophysiology of ACC. Patients with ACC usually present with vaginal bleeding, and physical examination may reveal a firm, palpable mass that may be friable or ulcerated. Cervical ACC is thought to be a radiosensitive tumor, and early-stage patients treated with adjuvant radiation have shown improved outcomes than those seen in cases where surgery has been performed alone. This case is important because there are few case reports in the world, and it is the first case to be reported from Ethiopia.

Case presentation: Here we present a 65-year-old female patient presented with vaginal bleeding, and histomorphologic examination confirms the diagnosis of adenoid cystic carcinoma of the cervix.

Clinical discussion: Histologically, these tumors are composed of fairly uniform, small basaloid cells with scanty cytoplasm and rounded or angulated hyperchromatic nuclei. The cells are arranged in a cribriform pattern with central hyaline or mucinous material. Less frequent patterns including trabecular, tubular, solid, or undifferentiated patterns may be observed. Lymph vascular invasion is frequent. This case was confirmed to be primary adenoid cystic carcinoma of the cervix with all features.

Conclusion: ACC of the cervix is a rare, particularly aggressive neoplasm. It requires enhancement of postoperative treatment regimens and careful follow-up and thus needs to be distinguished from other tumors with similar histologic aspects. So histopathologic examination with IHC correlation is strongly advised to diagnose this aggressive tumor.

Introduction and importance: Posttraumatic boutonnière deformities are complex clinical problems that are often poorly understood. Nevertheless, there are no established therapy guidelines, and there is little data to support the various treatment outcomes. In this report, we want to report on the treatment using an ala carte approach of already established procedures.

Case presentation: An 18-year-old male, complained about a crooked left middle finger for 1 year before admission, with a history of traumatic injury due to getting slashed by a machete. The operative procedure of releasing the central slip, lateral band, and transverse retinacular ligament, reconstruction using the Ohshio method, terminal tendon tenotomy, and fixation using K-wire. Intraoperative range of motion was evaluated. After 3 months post-operation, the patient was able to do full flexion and extension of the middle finger and after 1 year follow-up, the alignment and the function were satisfactory.

Clinical discussion: Chronic boutonnière deformity occurs when central slip injury prevents full PIP joint extension, causing lateral slip tension and DIP extension. Acute cases benefit from splinting and rehabilitation to avoid permanent deformities. Splinting, including relative motion flexion splinting, is crucial early on. For chronic cases, surgery such as the Curtis procedure or central slip tenotomy may be necessary. The Curtis method involves staged tendon repair, while tenotomy focuses on direct tendon reconstruction. Both approaches show promising results but may leave residual lag. Individualized treatment and timely intervention are essential for optimal outcomes.

Conclusion: The Ala carte approach of reconstruction procedure using anesthesia yields good results. The importance of an intraoperative active range of movement evaluation plays a crucial role so that correction can be made accordingly.