International Journal of Surgery Case Reports最新文献

Introduction: Fournier's gangrene, a polymicrobial infection affecting the scrotum and perineal area, predominantly affects elderly males, presenting challenges in diagnosis and management. This report examines two cases, with a focus on the rare outcome of bilateral orchidectomy.

Case presentation: A 69-year-old diabetic male presented with severe penile and scrotal pain, leading to the diagnosis of Fournier's gangrene. In another case, a 91-year-old male with a history of Benign Enlargement of the Prostate experienced scrotal pain and ulcerative lesions, resulting in a rapid progression of gangrene. The surgical approaches encompassed multiple debridement and bilateral orchidectomy, underscoring the intricate nature of managing Fournier's gangrene.

Discussion: Fournier's gangrene typically originates as a polymicrobial infection in the genitourinary or perianal regions, with common risk factors including diabetes, immunosuppression, and advanced age. Diagnosis often relies on clinical assessment, though imaging aids in complex cases. Early intervention with broad-spectrum antibiotics and repeated debridement remains the cornerstone of treatment.

Conclusion: Fournier's gangrene, a rare condition, poses diverse clinical presentations, management strategies, and outcomes. Early recognition, aggressive surgical debridement, and a multidisciplinary approach are essential in managing this condition.

Introduction: Ectopic pregnancies are a significant clinical concern, with 90 % occurring in the fallopian tubes. However, they can also manifest in other locations, including the cervix, ovary, and abdominal cavity. Abdominal pregnancies, which constitute less than 1 % of ectopic pregnancies, are associated with considerable morbidity and mortality. Among these, pregnancies located in the broad ligament are particularly rare and can sometimes be carried to term.

Case presentation: This case report discusses a 27-year-old patient presenting with a 14-week pregnancy diagnosed in the broad ligament, highlighting the challenges in prenatal diagnosis and the potential complications associated with this condition. The report details the clinical management, including an exploratory laparotomy and subsequent treatment, and underscores the importance of awareness and timely intervention in cases of broad ligament ectopic pregnancies. This case contributes to the limited literature on this uncommon type of ectopic pregnancy and emphasizes the need for further research to improve diagnostic and therapeutic approaches.

Clinical discussion: Ectopic pregnancy of the broad ligament is a relatively rare pathology documented in the literature. Its diagnosis is clinical and paraclinical, especially if ultrasound is performed early. Management is similar to that of an abdominal pregnancy. Maternal prognosis can be difficult if management is less than optimal in terms of surgery, anesthesia, resuscitation and the absence of blood products. This is why first-trimester ultrasound is so important.

Conclusions: This case underscores the importance of awareness and timely intervention in managing broad ligament ectopic pregnancies, and highlighting the need for further research to improve diagnostic and therapeutic approaches.

Introduction: An Inflammatory abdominal aortic aneurysm (IAAA) is an inflammatory condition involving the abdominal aorta, accounting for 4-7 % of all abdominal aortic aneurysms (AAAs). In general, AAA is asymptomatic, but IAAA can have some features, including pain, constitutional symptoms, elevated inflammatory markers, and distinguishes findings on imaging.

Presentation of case: This article is about a 65-year-old man with flank pain who was diagnosed incidentally with IAAA and underwent surgery.

Discussion: Surgery (open or endovascular) is the mainstay treatment for AAA, but in IAAA, due to the inflammatory process, making a good decision is a challenge.

Conclusion: In this study open aortic reconstruction was the procedure of choice, and it was done successfully.

Introduction: Accessory breast tissue is a rare condition occurring in 1-3 % of males, primarily in the bilateral axillary region. Kajava Class I accessory breast, characterized by glandular tissue, an areola, and a nipple, is rarely reported. This case report highlights the clinical presentation, diagnostic approach, and management of this rare entity in an elderly male.

Case presentation: A 72-year-old male presented with a left axillary swelling since his early twenties. Initially painless and lemon-sized, the mass progressively enlarged, extending over the left chest and flank, causing dis- comfort and restricting daily activities. Physical examination revealed a large, pedunculated mass measuring 25x15x10 cm in the left axilla, with a smooth surface and no skin color changes except in the nipple and areolar region. Diagnostic imaging and cytology confirmed the presence of glandular tissue, and biopsy validated the diagnosis with histologic findings that showed lobules of glandular tissue lined by bland, single-layered ductal and myoepithelial cells, disposed in a fibrous growth background. Additionally, there were foci of bland fat tissue in the histology. Surgical removal of the mass resulted in a successful outcome.

Clinical discussion: The occurrence of Kajava Class I accessory breast tissue in an elderly male is rare. It is important to consider accessory breast tissue in the differential diagnosis of long-standing unilateral axillary swellings. The diagnostic approach included clinical examination, imaging, and histopathology. Surgical excision provided symptomatic relief and pre- vented potential complications such as malignancy.

Conclusion: Kajava Class I accessory breast tissue, though rare, should be considered in elderly males with long-standing unilateral axillary swelling. Early recognition and surgical intervention are crucial for optimal outcomes.

Introduction and importance: Most extrahepatic metastases of hepatocellular carcinoma (HCC) are to the lungs and bones, metastases to the colon are rare. In the present study, we experienced a case of metastasis to the ascending colon during repeated treatment for HCC. Case Presentation: A 63-year-old man was diagnosed with multiple HCCs (T4N0M0 stage IIIB) associated with portal vein invasion. Transcatheter arterial chemoembolization (TACE), transarterial infusion (TAI) and radiofrequency ablation (RFA) were performed, and partial response was achieved, but the main nodule at S6 lesion subsequently recurred to protrude outside of the liver. A partial hepatic S6 resection was performed for local control 1.5 years after the initial treatment. IVR was then performed again, but approximately 8 months after hepatic resection, an abdominal computed toography (CT) showed a mass lesion in the ascending colon. After a total colonoscopy and biopsy, a diagnosis of colorectal metastasis of HCC was made. A right hemicolectomy was performed for local control. The patient had a good post-operative course, but developed liver failure due to rapid growth of the tumor thrombus of the main portal vein and died of primary disease approximately 3.5 months after the colon resection. Clinical Discussion: The metastasis of HCC to the colon is an extremely rare occurrence. Conclusion: One possible reason for this rarity is that portal vein tumor thrombosis (PVTT) results in colorectal metastasis via trans-portal retrograde metastasis.

Introduction and importance: Synovial sarcoma (SS) is a high-grade malignancy, accounting for 2.5-3.5 % of all primary H&N sarcomas and 0.1 % of all H&N cancers.

Case presentation: A 26-year-old woman presents with dyspnea and dysphonia. Flexible nasofibrolaryngoscopy and CT were performed with evidence of a laryngeal tumor. Total laryngectomy was performed due to a histopathological report of laryngeal synovial sarcoma.

Clinical discussion: Primary SS of the H&N is rare and accounts for <5 % of all synovial sarcomas and laryngeal-origin SS represents a rare subset within H&N sarcomas. There are 3 different histologic subtypes: biphasic, monophasic and poorly differentiated. Immunohistochemistry plays a crucial role in histologic diagnosis. The optimal treatment of synovial sarcoma is multimodal, depending on its size, location and grade. Radical surgical excision with negative margins is generally accepted as the mainstay of treatment. Disease recurrence is a significant problem, with up to 45 % of patients developing local disease and 33 % developing metastatic disease.

Conclusions: Laryngeal SS is exceptionally rare, requiring complex, multidisciplinary management.

Introduction: This case report presents a rare instance of a ureteral stent, fashioned from a nasogastric tube, migrating into the inferior vena cava (IVC). The report underscores the importance of timely diagnosis and intervention to prevent severe complications.

Presentation of case: A 38-year-old woman presented with a ureteral stent, made from a nasogastric tube, found in the IVC following a previous surgery. The foreign body was surgically retrieved, and the patient had an uneventful recovery.

Discussion: Endovascular foreign bodies pose significant risks and should be promptly removed to prevent severe complications. In this case, surgical intervention was chosen due to the lack of available endovascular instruments and expertise.

Conclusion: Timely surgical intervention and vigilant monitoring are crucial for managing intravascular foreign bodies to ensure successful outcomes.

Introduction and importance: Leriche syndrome (LS), or aortoiliac occlusive disease, is a rare form of peripheral arterial disease leading to claudication, impotence, and diminished femoral pulses due to atheromatous obstruction of the infrarenal aorta and common iliac arteries. Early identification is crucial as untreated LS can result in severe complications. Treatment primarily involves surgical interventions, with endovascular options considered as alternatives.

Case presentation: A 30-year-old former smoker woman presented with calf pain after walking less than 50 m, coupled with a history of recurrent lower extremity arterial occlusions and previous abdominal aorta stenting. Examination revealed pallor and non-palpable pulses in both feet. Doppler imaging and CT scans indicated significant aortic stenosis and iliac artery occlusion. Following a successful bilateral aorto-femoral bypass, distal pulses improved, and the ankle-brachial index was 1 in both limbs. The patient was prescribed warfarin for ongoing management, emphasizing the importance of timely intervention in LS to restore limb perfusion.

Clinical discussion: LS is characterized by atheromatous obstruction of the infrarenal aorta and iliac arteries, causing claudication and absent femoral pulses. Diagnostic tools include the ankle-brachial index, Doppler ultrasound, and CT angiography. Management typically involves aortofemoral bypass or endovascular revascularization, coupled with lifestyle modifications.

Conclusion: Leriche syndrome poses significant morbidity if undiagnosed. This case highlights its impact on quality of life and limb ischemia risk, underscoring the need for accurate diagnostics and timely, personalized management for improved outcomes. Increased clinician awareness is vital for optimal care.

Introduction and importance: Dilation and stretching of the collecting system of the kidney due to obstruction of urine flow is called hydronephrosis. This case may be accompanied by the presence of pus known as pyonephrosis. This case report reporting massive pyonephrosis in pediatrics related to management and source of control.

Case presentation: A 10-year-old boy came in with the main complaints of high fever, decreased appetite, vomiting, and nausea. The examination showed left severe hydronephrosis (+) with a size of 14.59 × 6.9 × 9.2 cm. The patient underwent percutaneous nephrostomy (PCN) and showed pus production. From the antegrade pyelography (APG) during PCN, it was stenosis of the left ureteropelvic junction (UPJ). Empirical antibiotics were administered, followed by albumin transfusion. Antibiotics were changed on day 3 post-PCN when urine culture results showed Staphylococcus aureus. After successful improvement of the general condition and minimal pus production from PCN, the patient had a Double J Stent (DJ) and pyeloplasty on the left UPJ. The patient was discharged on day 4 after the left pyeloplasty.

Clinical discussion: Management of UPJ Stenosis with massive hydronephrosis complications can be done in two stages with the first stage being the diversion of pus from the kidney, then followed by pyeloplasty management. Management is continued with nephrostomy or ureteral stent placement for urine diversion. Management of bacterial infections is adjusted according to culture results.

Conclusion: Management of hydronephrosis with pyonephrosis as complications can be be carried out in two stages, pus diversion, then followed by the pyeloplasty.

Introduction and importance: Basal cell carcinoma is the most common non-melanoma skin cancer, tightly connected to ultraviolet exposure, and typically occurs on sun-exposed areas, including the nose. Reconstructing defects in the nasal tip following the removal of basal cell carcinoma lesions presents significant challenges, requiring a balance between completely removing the cancerous cells and achieving an optimal aesthetic result, especially since this area is central to the face.

Case presentation: We present the case of a 62-year-old male patient with a 2 × 3 cm tumor located at the nasal tip, initially diagnosed as a benign vascular tumor based on clinical examination and imaging results. The tumor had been progressively growing over the past three years, interfering with the patient's daily activities, and prompting his desire for its removal. A surgical excision of the tumor was performed, using a local flap incorporating Burrow's triangles to minimize skin tension and optimize aesthetic outcomes. The patient made a good recovery, and the wound healed well. However, histopathological analysis revealed residual tumor cells at the resection margin.

Clinical discussion: Reconstructing defects after excising basal cell carcinoma from the nasal tip is challenging and tumor removal must ensure complete cancer excision while preserving the nasal structure. Local flap reconstruction is often preferred for better cosmetic results.

Conclusion: Careful planning and wide excision margins are crucial, as basal cell carcinoma can resemble benign lesions, as shown in our case.