International Journal of Surgery Case Reports最新文献

Introduction and importance: Hydatidosis is a cosmopolitan zoonosis caused by larval stages of Echinococcus granulosus. The brain is a rare location for this disease to occur, especially in adults. The occipital location is extremely unusual and the cysts are usually solitary. Cerebral hydatid cysts may be primary or secondary. Primary multiple bilateral cerebral hydatid cysts are extremely uncommon. This case aims to highlight the diagnostic process and surgical management of primary bilateral hydatid cysts.

Case presentation: We present the case of a 36-year-old Tunisian man admitted to our institution for headache and visual impairments. Neurological examination revealed bilateral decreased visual acuity. Cranial MRI showed two primary bilateral occipital hydatid cysts. The patient underwent successful surgical excision using two craniotomies in a single procedure.

Clinical discussion: Primary multiple bilateral cerebral hydatid cysts are extremely rare. The pathogenetic mechanisms of this entity are not yet precisely known. Clinical symptoms vary depending on the location of the cysts in the brain. Several diagnostic methods can be used, computed tomography and especially magnetic resonance imaging, which represent the gold standard in the diagnosis of multiple and bilateral cerebral hydatid cysts. The treatment of primary multiple hydatid cysts is exclusively surgical. The key to an optimal result is careful surgical technique that avoids preoperative ruptures and complications.

Conclusion: Primary multiple cerebral hydatidosis is extremely rare, even in endemic areas. Diagnosis is by imaging techniques and treatment is primarily surgical. With a careful surgical strategy and appropriate postoperative management, patients can recover without neurological sequelae.

Introduction: Renal angiomyolipoma is the most common benign kidney tumor, representing 1-3 % of solid renal tumors. Despite its benign nature, it can be associated with lethal hemorrhage, and can also show signs of local extension mimicking malignant tumors. The cornerstone of treatment remains angioembolization and nephron sparing surgery.

Presentation of case: A 51-year-old Nepalese woman presented to the emergency department with acute abdominal pain and signs of hypovolemic shock. She was managed with resuscitation, followed by angioembolization of a left renal artery pseudoaneurysm. A few months later, she underwent laparoscopic nephron-sparing surgery. One year later, she had excision of a recurrent left angiomyolipoma. Both the initial and final histologic examinations confirmed the diagnosis of classic variant renal angiomyolipoma.

Discussion: Although transcatheter angioembolization is the treatment of choice for bleeding angiomyolipoma, there is a higher likelihood of re-embolization and the need for surgical excision. Therefore, surgeons should carefully consider treatment options and discuss the pros and cons of each with the patient and their family, taking into account the available infrastructure and expertise.

Conclusion: We report a rare and interesting case of acutely bleeding angiomyolipoma. The patient was successfully treated with angioembolization followed by laparoscopic nephron-sparing surgery. However, the tumor recurred a year later, necessitating conversion to open nephron-sparing surgery.

Introduction: Ectopic pancreatic tissue (EPT), also known as Heterotopic pancreas (HP), is a rare congenital anomaly characterized by the presence of pancreatic tissue outside the primary organ. This report presents a case of EPT incidentally discovered in the submucosal area of the small intestine.

Case presentation: A 56-year-old male presented to the emergency department following a high-speed car collision, reporting abdominal pain after impact with the steering wheel. Physical examination revealed left upper quadrant tenderness. Imaging studies showed free fluid in the abdominal and pelvic cavities, mesenteric damage, and increased intestinal wall thickness. Surgical exploration confirmed hemoperitoneum and a non-viable 30 cm segment of the small intestine, which was resected. Subsequent pathological examination revealed a 1.5 cm submucosal mass, diagnosed as EPT. The patient recovered uneventfully and was discharged in stable condition.

Clinical discussion: Clinically significant lesions are typically larger than 1.5 cm and involve the mucosa, with pain as the most common symptom. They can also cause severe complications such as intestinal obstruction, perforation, peritonitis, and gastrointestinal bleeding. Additionally, EPT can be associated with malignant transformations.

Conclusion: While often asymptomatic, EPT can lead to significant complications, making surgical resection essential for both symptomatic and incidental cases, particularly since diagnosis is frequently established postoperatively through histological examination. Although trauma may not directly cause EPT, its management in emergency settings can facilitate evaluations that reveal lesions capable of causing severe complications if left undiagnosed. Given the diverse symptoms associated with this condition, EPT should be considered in the differential diagnosis of intestinal lesions.

Introduction: Orbital leiomyoma can occur anywhere within the orbit. Posterior tumors arise from vessel wall smooth muscle cells, while anterior tumors develop from the capsulopalpebral or Muller muscle.

Presentation of case: we present a case of a 24-year-old man who was referred for evaluation of chronic right eye swelling involving the medial upper eyelid. Ophthalmologic examination was unremarkable apart from upper lid fullness along with downward and lateral displacement of the globe. MRI revealed a large and well-defined growth in the right medial orbital space. An excisional biopsy was performed which showed a friable mass strongly adherent to the underlying conjunctiva and Muller muscle. This case report has been prepared and reported in line with the SCARE criteria.

Discussion: Orbital leiomyoma usually presents with progressive painless proptosis if situated deep in the orbit. Our patient presented mainly with eyelid fullness and displacement due to the anterior location of his tumor. The diagnosis of orbital leiomyoma has to be confirmed by histopathological and immunohistochemical assessments such as in our case. A literature review was conducted using multiple databases spanning from 1963 to 2023 which concluded male predominance. One similar case to ours has been reported with the tumor originating from supraorbital neurovascular bundle.

Conclusion: To the best of our knowledge, this is the first reported case of an orbital leiomyoma originating from the Muller muscle in the English literature.

Introduction: Pseudotumors are well-known complications following total hip arthroplasty (THA), usually attributed to debris-induced inflammation from direct metal-on-metal contact between implants. In total knee arthroplasty (TKA), the traditional use of polyethylene as a bearing surface prevents direct metal articulation. Thus, pseudotumor formation in TKA usually suggests atypical metal interaction between the prosthetic components.

Presentation of case: We presented the case of a 65-year-old male who developed a progressively growing mass in the left posterior knee after revision TKA, debuting as heterotopic ossification (HO) based on the radiographic assessment. Subsequent histopathological examination establishes the diagnosis of a pseudotumor.

Discussion: Pseudotumors impose a diagnostic challenge in TKA due to their non-specific presentation and imaging, which may overlap with other etiologies. Currently, there are no standardized guidelines for pseudotumor assessment in TKA, and each case should be approached individually without relying on a simple diagnostic tool.

Conclusion: Physicians should consider a comprehensive approach supported by a high index of suspicion to include pseudotumors within the differential diagnosis of knee periprosthetic masses.