International Journal of Surgery Case Reports最新文献

Introduction: Patellar sleeve fracture is a rare fracture common in children between the age of 8 and 16 years but rare in adults. We report a case of 22 year old male with inferior patellar sleeve fracture following motorbike accident.

Case presentation: The case study presents a twenty-two year old boy who sustained inferior patellar Sleeve fractures following motor bike accident. The patient presented to ER with pain and swelling along with abrasion. Diagnostic workup, including blood test and imaging, confirmed the diagnosis, revealing elevated inflammatory markers and evidence of inferior patellar sleeve fracture on X-ray. The fracture was managed by Open reduction and internal fixation with ortho cord suture.

Discussion: Sleeve fractures of the patella in children usually occur in the inferior pole of the patella, very rarely in the superior pole. However, sleeve fractures of the patella mainly affect the superior pole in adults. The mechanism of sleeve fracture is a rapid contraction of the quadriceps on a flexed knee. Sleeve fractures usually occur in individuals involved in explosive acceleration activities such as jumping, although high-energy sports such as skateboarding are now also considered common causes Clinically, treatment options including conservative and surgical treatment depends on the severity of bone displacement and the extensor mechanism of the knee.

Conclusion: Inferior patellar sleeve fracture is rare in adults in comparison to the children. The fracture is confirmed through X-rays AP and Lateral view. Thus, diagnosed fracture is treated surgically via open reduction and internal fixation.

Introduction: Gastrointestinal stromal tumors (GIST), which occur anywhere in the gastrointestinal (GI) tract, typically occur in the stomach and small intestine but rarely in the duodenum. We present a case report wherein a descending duodenal GIST was treated with a limited, minimally invasive surgery after endoscopic nasobiliary drainage (ENBD) insertion.

Presentation of case: A 67-year-old woman visited our hospital with an incidentally discovered duodenal tumor. Gastroduodenoscopy revealed a duodenal subepithelial tumor (SET) measuring approximately 2 cm in descending duodenum. Endoscopic ultrasound revealed a well-circumscribed, inhomogeneous hypoechoic lesion measuring approximately 17 × 4.6 mm, thought to arise from the muscularis layer. Computed tomography (CT) revealed an inhomogeneous enhancing mass with central necrosis, measuring approximately 2.7 cm, in the descending duodenum. Pathological findings from the bite-on-bite biopsy showed c-kit and DOG-1 positivity and CD34 and desmin negativity, leading to a GIST diagnosis. Laparoscopic wedge resection with preoperative ENBD insertion was planned due to the risk of pancreaticobiliary duct (PBD) damage during surgery because the lesion was located near the ampulla of Vater (AoV) and minor papilla. Surgery was performed using laparoscopic wedge resection without PBD injury. The patient was discharged 10 days post-surgery without complications.

Discussion: Descending duodenal GIST is difficult to operate on with minimally invasive surgery. However, if the size is not excessive and the PBD is not involved, minimal and limited surgery is possible after ENBD insertion.

Conclusion: We report the first case of limited and minimally invasive surgery followed by ENBD insertion in a rare descending duodenal GIST.

Introduction and importance: Pancreatic schwannoma (PS) is an extremely rare benign tumor also known as neurilemoma or neuroma. The majority of PS develop cystic lesions, and its preoperative diagnosis is challenging due to its tendency to mimic other lesions of the pancreas. Herein, we reported a case of body PS incidentally discovered in an 81-year-old male, which was successfully treated through enucleation.

Case presentation: We report the case of a 81-year-old man. Who presented with a well-defined polycystic-tumor of about 2cm at the pancreatic body, overdrawn by a computed tomography scan, incidentally discovered. The patient underwent a laparotomy, and we performed an enucleation of the tumor successfully. Histopathological examination revealed spindle-shaped cells. Immunohistochemically studies showed S100-protein expression, confirmed a body pancreatic schwannoma. The postoperative course was uneventful.

Clinical discussion: Schwannomas are rare mesenchymal-tumors, with PS accounting for only 1 % of cases. They are often difficult to diagnose as they mimic other pancreatic tumors. Imaging techniques like CT, MRI, and EUS-FNA aid in detection, but definitive diagnosis requires histological and immunohistochemical analysis. Treatment is typically enucleation for benign tumors, but larger or malignant tumors may need more extensive resections. Due to diagnostic challenges, aggressive surgeries are common. Prognosis is generally favorable, but regular follow-ups are recommended to monitor for recurrence.

Conclusion: Although pancreatic schwannoma is rare, it should be included in the list of differential diagnoses of pancreatic masses, both solid and cystic. Both enucleation and radical surgical resections have revealed great therapeutic efficiency with a well prognosis without recurrences.

Introduction and importance: Fallopian tube cancer, particularly the carcinosarcoma subtype, is a rare malignancy posing diagnostic challenges.

Case presentation: Our patient was an 83-year-old, nulligravida woman, presented to our outpatient clinic with one month of pelvic pain. On examination, a pelvic mass was detected. MRI suggested a cystic tumor in the fallopian tube, and pyosalpinx was initially suspected. Laparoscopic surgery was performed. However, she was later diagnosed with carcinosarcoma of the fallopian tube, according to the pathological diagnosis. The disease rapidly recurred and metastasized, including the development of Port-Site Metastasis (PSM). The patient underwent PSM excision surgery based on her request, which contributed to her mental well-being.

Clinical discussion: Diagnosing fallopian tube cancer is difficult, and there is often a misdiagnosis risk during surgery, leading to potential errors in treatment. MRI can help identify fallopian tubal cancer, but its features can also resemble benign conditions. Factors like infertility and chronic inflammation can increase the suspicion of cancer. Preventive measures for PSM during laparoscopic surgery are crucial. While it's unclear if removing port-site metastases improves the prognosis, it may benefit the patient's mental health.

Conclusion: Our findings underscore the importance of considering the possibility of malignancy when treating tubal tumors. We should take preventive measures for PSM during laparoscopic surgery. PSM excision surgery could be an option to enhance patient's mental health.

Introduction and significance: Zenker's diverticulum is a rare condition characterized by a false diverticulum, as a true diverticulum involves herniation of all wall layers outward. Dysphagia, difficulty in swallowing, is the most common symptom. Diagnosis is primarily made through X-ray studies using contrast material during swallowing. Treatment options include open surgery or endoscopy.

Case presentation: We present the case of an adult male who experienced progressive dysphagia for approximately two years. A diagnosis of Zenker's diverticulum was confirmed by radiography following unsuccessful endoscopic treatment and a subsequent perforation of the diverticulum. The patient underwent successful open surgery after adequate preoperative preparation.

Clinical discussion: Zenker's diverticulum is an uncommon cause of pharyngeal dysphagia, but it should be considered in the differential diagnosis due to the importance of early intervention and prevention of malignancy. The endoscopic approach carries a significant risk of perforation, necessitating careful treatment and close monitoring during and after the procedure.

Conclusion: The endoscopic approach is considered the best treatment method for Zenker's diverticulum and should be used with caution to avoid complications, especially perforation, which makes open surgery the most appropriate treatment in this case.

Introduction: Mesenchymal chondrosarcoma (MC) is a high-grade variant of chondrosarcoma, essentially composed of poorly differentiated spindle cells interspersed with areas of cartilage or chondroid matrix. MC is extremely rare; it only accounts for 0.1 % of head and neck tumors and for only 1 % of all chondrosarcomas (CSs).

Case presentation: A 21-year-old man presented with a medical history of a painful irritation at the dextral maxillary region, presented as a mass at the vestibule of the oral cavity near the upper molars, and had been misdiagnosed as a benign fibrous lesion and excised without performing a biopsy. Magnetic resonance imaging (MRI) revealed an invasive lesion filling the right maxillary sinus and penetrating the orbital floor. A biopsy was then performed and revealed an MC.

Clinical discussion: The patient underwent a wide surgical resection, except for the infraorbital region, in which the tumor was surrounded by a fibrous capsule separating it from the anatomical structures of the eye. Due to the lack of wide resection in the orbital floor area (to preserve the eyeball), we applied the chemotherapy that was done with cisplatin and doxorubicin.

Conclusion: Confirmed diagnosis by biopsy and treatment, both surgical and chemical, with frequent follow-up are decisive factors in progressing MC.

Introduction: Duplication of the gallbladder is a rare congenital malformation associated with the development of cholelithiasis. It increases the risk of iatrogenic bile duct injury during cholecystectomy and can lead to symptom recurrence if missed. Although preoperative imaging is helpful, detection rates are around 50 %.

Case presentation: A 36-year-old healthy female with symptomatic gallstone disease and ultrasonographic evidence of cholelithiasis was scheduled for elective laparoscopic cholecystectomy. Following standard four port entry and dissection of pericholecystic adhesions to duodenum, a V shaped duplicated gallbladder with calculi, and a common cystic duct and artery was noted. The cystohepatic triangle was dissected, critical view of safety demonstrated and the common cystic duct and artery were divided between clips.

Discussion: Variations in gallbladder morphology has been described by Gross, Boyden and Harlaftis classification. Type 1 (bilobed gallbladder) has a common embryological origin with an invaginating septum separating the lumens while type 2 (double gallbladder) has a double embryological origin with separate gallbladders and their own cystic ducts. Many cases go undetected or are mis-identified as choledochal cyst, diverticulum or Phrygian cap. MRCP is the imaging modality of choice for suspected duplicate gallbladder.

Conclusion: Careful dissection of the cystohepatic triangle with attention to critical view of safety is important in all cases as numerous variations in hepatobiliary anatomy have been described. Surgical awareness of these variations and good surgical technique will promote safe laparoscopic cholecystectomy even in the most unexpected of encounters.

Introduction and importance: Retiform hemangioendothelioma(RH) is a rare vascular tumor affecting patients over a wide age range without a gender predilection; only about 50 cases have been described so far.

Case presentation: We report a case of submandibular retiform hemangioendothelioma in a 58-year-old woman who had been diagnosed with RH 20 years ago and had experienced recurrence four times during the past 20 years. This will increase the limited number of such cases in the hope of gaining a better understanding of this rare type of tumor. The histological features of RH are characterized by arborizing blood vessels arranged in a testicular network pattern with endothelial cells arranged in a hobnail pattern. Immunohistochemistry revealed CD31, CD34, ERG, and other vascular markers.

Clinical discussion: Based on the morphological and immunohistochemical results, we diagnosed the patient with a rectiform hemangioendothelioma with local malignancy that transformed into angiosarcoma, with enlargement of the lymph nodes in the neck area, possibly indicating tumor lymph node metastasis. The patient underwent extended resection and completed 14 radiotherapy sessions. Follow-up at 3 months after surgery showed no recurrence.

Conclusion: RH is a low-grade malignant intermediate vascular tumor that is prone to recurrence and does not generally metastasize to distant sites. Patients with recurrent relapses may undergo malignant transformation or lymph node metastases. Treatment primarily relies on wide excision and adjuvant radiotherapy may be necessary when required.

Introduction: Retinal capillary hemangioma (RCH) is a benign vascular hamartoma that can occur sporadically or as a manifestation of Von Hippel-Lindau (VHL) disease. If left untreated, it results in adverse ocular complications depending on its location and eventual visual loss.

Case presentation: We present a 50-year-old man who was a known case of VHL with history of left eye vision loss in the left eye at the age of 30 years. He underwent resection of a brain hemangioblastoma 10 years earlier, which was complicated by left facial nerve palsy. He presented with acute left eye pain, redness, and eyelid swelling. He had large corneal infiltrate with hypopyon and obscured fundus view. He was treated medically as a case of left endophthalmitis with no improvement. The eye was eventually eviscerated. Histopathological examination revealed acute necrotizing keratitis, osseous metaplasia, and long-standing RCH.

Discussion: Peripheral RCHs are the most encountered ocular vascular lesion in VHL disease. Other locations close to the optic nerve (juxtapapillary) result in complicated visual loss. The RCH in our VHL case was confirmed 20 years after the history of vision loss in the same eye. The patient also had confirmed surgically treated intracranial hemangioblastoma but didn't seek any ophthalmic care prior to his recent presentation with painful acute keratitis and endophthalmitis.

Conclusion: VHL has multiple organ involvement. Patients suspected or diagnosed with VHL should receive prompt health care counselling to ensure periodic eye examination for control of any intraocular vascular lesions to prevent visual loss.

Introduction and importance: Oral Lymphangioma is a rare benign tumor that arises from the lymphatic vessels in oral cavity. It is a development defect in the lymphatic system, which is less common than other types of vascular anomalies, and the incidence in the general population is very low, especially in the oral cavity. It typically presents as soft, painless swelling, often found on the tongue, lips or floor or the mouth. The lesions can vary in size and may have a translucent appearance, sometimes resembling a cyst.

Case presentation: A 13-year-old male complaint of congenital diffuse, painless swelling of the lateral side of the tongue. The swelling was soft and compressible and involved half of the tongue. Incisional biopsy from the lesion can confirm the diagnosis by showing dilated lymphatic vessels histologically.

Clinical discussion: Oral lymphangioma is a rare tumor found in the oral cavity, occurring at various sites but most commonly on the tongue. This often leads to macroglossia, presenting as a compressible, painless swelling that typically necessitates surgical excision when it causes functional issues.

Conclusion: Oral lymphangioma generally has a good prognosis, especially when treated appropriately. However, they can recur if not completely excised.