International Journal of Surgery Case Reports最新文献_第8页

Gallbladder-preserving cholelithotomy in selected patients with symptomatic cholelithiasis: A case series 保留胆囊的胆石切开术治疗有症状的胆石症：一个病例系列

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-25 DOI: 10.1016/j.ijscr.2025.112097

Hakan Özgür Akıncı , Ozan Şen , Rıfat Tokyay , Deniz Dalayman , Mehmet Tekinel

İntroduction and importance

Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of symptomatic cholelithiasis, but is associated with post cholecystectomy problems in some patients. However, some patients refuse cholecystectomy against organ loss. In suitable patients we employed gallbladder preserving cholelithotomy (GPC) with mini-incision to rid of their stones. Our aim is to introduce our technique of GPC and investigate its safety and efficacy.

Case presentation

Fifty-five biliary colic patients with a strong desire to retain their gallbladders harboring ≤3 gallstones with diameters <3 cm, wall thickness ≤3 mm, and gallbladder ejection fractions >50 % underwent GPC. Assessment of the gallbladder features by ultrasonography every 3 months in the first postoperative year and annually thereafter. We conducted the gastrointestinal quality of life index (GIQLI) survey in the 6th postoperative month.

Clinical discussion

Fifty-two patients had their gallstones successfully removed. We did not encounter any perioperative complication. We converted to laparoscopic cholecystectomy in three patients, one with multiple polyps and two with inflamed mucosa. Gallbladder ejection fractions in the 3rd postoperative month were statistically better than the preoperative period. The patients with preoperative symptoms were symptom free. The median follow-up time was 3 years. There was no stone recurrence.

Conclusion

GPC is a simple, safe and acceptable procedure. It may be employed in suitable symptomatic patients.

İntroduction和重要性腹腔镜胆囊切除术（LC）是治疗症状性胆石症的金标准，但在一些患者中与胆囊切除术后的问题相关。然而，一些患者因器官损失而拒绝胆囊切除术。在合适的患者中，我们采用保留胆囊的小切口胆石切开术（GPC）去除结石。我们的目的是介绍我们的GPC技术，并探讨其安全性和有效性。病例表现：55例胆绞痛患者均有保留胆囊的强烈愿望，其中胆结石≤3颗，直径≤3cm，壁厚≤3mm，胆囊射血分数≤50%，行GPC。术后第一年及以后每年每3个月进行一次胆囊超声检查。术后6个月进行胃肠生活质量指数（GIQLI）调查。临床讨论52例患者成功切除胆结石。我们没有遇到任何围手术期并发症。我们对3例患者进行腹腔镜胆囊切除术，其中1例为多发息肉，2例为黏膜炎症。术后第3个月胆囊射血分数明显优于术前。术前有症状的患者无症状。中位随访时间为3年。无结石复发。结论该方法简便、安全、可接受。它可用于适当的症状患者。

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引用次数: 0

Clinical course and imaging-guided medical treatment of a posterior lingual abscess: A rare but manageable deep neck infection 舌后脓肿的临床过程和影像学引导下的医学治疗：一种罕见但可控的深颈部感染

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-25 DOI: 10.1016/j.ijscr.2025.112108

Malika El Omri, Nawress Thabet, Imene Boukattaya, Mouna Bellakhdher, Wassim Kermani

Introduction and importance

Lingual abscesses are rare but can be life-threatening due to potential airway obstruction. Timely recognition is crucial for effective management. We present a case of a lingual abscess and review its clinical presentation, progression, and treatment options.

Case presentation

A 38-year-old man with no significant medical history presented with a seven-day progression of worsening odynophagia and dysphagia. He had received prior empirical treatment with antibiotics and corticosteroids without improvement. Physical examination revealed swollen speech and limited tongue protrusion. Computed tomography (CT) identified a posterior lingual abscess. The patient received medical treatment based on amoxicilline-clavulanic acid, leading to successful resolution of symptoms and the abscess within 8 days.

Clinical discussion

This case underscores the importance of considering lingual abscesses in patients with odynophagia and dysphagia. Due to their rarity and nonspecific symptoms, diagnosis can be challenging. Imaging studies, particularly CT scans, are essential for accurate diagnosis and guiding treatment strategies.

Conclusion

Early intervention is vital to prevent complications such as airway obstruction. While surgical drainage is often recommended, some cases may resolve with medical management alone, as demonstrated in this patient. Clinicians should maintain a high index of suspicion for lingual abscesses to ensure prompt and appropriate treatment.

简介和重要性舌脓肿是罕见的，但可能危及生命，由于潜在的气道阻塞。及时识别是有效管理的关键。我们提出一个病例舌脓肿和检讨其临床表现，进展，和治疗方案。病例表现：一名38岁男性，无明显病史，7天前出现吞咽困难和吞咽困难恶化。他之前接受过抗生素和皮质类固醇的经验性治疗，但没有好转。体格检查显示言语肿胀，舌部有限突出。计算机断层扫描（CT）发现后舌脓肿。患者接受阿莫西林-克拉维酸类药物治疗，8天内症状及脓肿成功消退。本病例强调了在吞咽困难患者中考虑舌脓肿的重要性。由于其罕见和非特异性症状，诊断可能具有挑战性。影像研究，特别是CT扫描，对于准确诊断和指导治疗策略至关重要。结论早期干预对预防气道阻塞等并发症至关重要。虽然外科引流经常被推荐，但一些病例可以通过单独的医疗管理来解决，正如本例所示。临床医生应该对舌脓肿保持高度的怀疑，以确保及时和适当的治疗。

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引用次数: 0

Retrograde intramedullary nailing for femoral shaft fracture with ipsilateral dynamic hip screw fixation for femur neck fracture; dual fixation. Case study 逆行髓内钉治疗股骨骨干骨折同侧动力髋螺钉固定治疗股骨颈骨折双重固定。案例研究

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-25 DOI: 10.1016/j.ijscr.2025.112093

Said Osman Dahir , Abdirahman Omer Ali , Mohamoud Hashi Abdi , Ridwan Mohamed Farah , Hodo Abdi Abdillahi , Hassan Elmi Moumin

Introduction

Ipsilateral femoral neck and shaft fractures are rare, high-energy injuries posing diagnostic and management challenges. Optimal treatment strategies remain debated. This case study presents a successful approach using dual fixation with retrograde intramedullary nailing and dynamic hip screw (DHS) fixation.

Case presentation

A 38-year-old male driver presented following a motor vehicle accident with right thigh and hip pain, swelling, and deformity. Radiographic evaluation revealed a transverse femoral shaft fracture combined with an ipsilateral, non-displaced transcervical femoral neck fracture.

Discussion

Dual fixation with retrograde femoral nailing for the shaft and DHS for the neck offers a stable construct while minimizing soft tissue disruption and potentially facilitating early weight-bearing. While open reduction and internal fixation can lead to complications, our chosen technique aimed to avoid them. Vigilant monitoring for complications like avascular necrosis, nonunion, and infection remains crucial. This case highlights the potential efficacy of dual fixation in achieving favorable outcomes in these complex fracture patterns.

Conclusion

Dual fixation using retrograde intramedullary nailing for femoral shaft fracture and DHS fixation for the ipsilateral femoral neck fracture represents a viable treatment option, especially in non-displaced neck fractures. Further research with larger cohorts is needed to validate these findings and establish definitive treatment guidelines.

同侧股骨颈和股骨骨干骨折是罕见的高能量损伤，给诊断和治疗带来了挑战。最佳治疗策略仍有争议。本病例研究介绍了逆行髓内钉和动态髋螺钉（DHS）固定双重内固定的成功方法。病例介绍：一名38岁男性司机在机动车事故后出现右大腿和臀部疼痛、肿胀和畸形。x线检查显示股骨横轴骨折合并同侧非移位的经颈股骨颈骨折。双内固定采用逆行股骨干内钉固定脊柱，DHS固定颈部，可提供稳定的结构，同时最大限度地减少软组织破坏，并可能促进早期负重。虽然切开复位和内固定可能导致并发症，但我们选择的技术旨在避免这些并发症。警惕监测并发症如缺血性坏死、骨不连和感染仍然至关重要。该病例强调了双重内固定在这些复杂骨折类型中获得良好结果的潜在疗效。结论逆行髓内钉治疗股骨骨干骨折和DHS固定治疗同侧股骨颈骨折是一种可行的治疗选择，特别是对于非移位的颈骨折。需要更大规模的进一步研究来验证这些发现并建立明确的治疗指南。

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引用次数: 0

Hybrid TEVAR and REBOA procedures prior to fracture reduction and fixation in a displaced C-type thoracic spine fracture with bony contact to the aorta – A case report 骨折复位和固定前混合TEVAR和REBOA手术治疗移位型c型胸椎骨折伴骨接触主动脉1例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-25 DOI: 10.1016/j.ijscr.2025.112107

Annika Ito , Felix Karl-Ludwig Klingebiel , Sandro-Michael Heining , Roland Bozalka , Hans-Christoph Pape , Michel Teuben

Introduction and importance

Spinal injuries, particularly C-type fractures, are common in polytrauma patients. Surgical priorities are strongly influenced by the severity of concomitant injuries and cardiopulmonary stability. Sagitally displaced C-type fractures are associated with risks such as increased blood loss from damaged vessels and the potential for aortic rupture.

Case presentation

This report describes a successful case of a 50-year-old male with a severe Th9 translational C-type spinal injury sustained in a motor vehicle accident. The patient presented with bilateral leg paresis and was hemodynamically stable. CT revealed direct contact to the aorta. A combined surgical strategy was used, including TEVAR for aortic protection and REBOA for hemorrhage control via the popliteal artery before surgical realignment and stabilization of the spine.

Discussion

This case demonstrates a novel and safe approach combining TEVAR and REBOA to manage high-risk thoracic C-type spine fractures with direct aortic contact. This allows surgical teams to achieve spinal realignment while minimizing the risk of catastrophic aortic injury. The utilization of popliteal artery access facilitates concurrent vascular and spinal intervention in the prone position.

Conclusions

Hybrid REBOA and TEVAR offers a safe strategy for managing severely displaced thoracic spinal C-type injuries if the aorta is injured or is at significant risk of secondary rupture i.e. during the repositioning maneuver. Utilizing the popliteal artery for vascular access allows for simultaneous spinal and minimally invasive vascular surgery.

Level of evidence

Level V – Single case report.

脊柱损伤，尤其是c型骨折，在多发创伤患者中很常见。外科手术的优先次序受到伴随损伤的严重程度和心肺稳定性的强烈影响。矢状面移位的c型骨折存在风险，如受损血管失血增加和主动脉破裂的可能性。本报告描述了一例50岁男性在机动车事故中严重Th9平移c型脊髓损伤的成功病例。患者表现为双侧腿瘫，血流动力学稳定。CT显示与主动脉直接接触。采用联合手术策略，包括TEVAR保护主动脉，REBOA通过腘动脉控制出血，然后手术调整和稳定脊柱。本病例展示了一种新的、安全的方法，结合TEVAR和REBOA来治疗主动脉直接接触的高危胸c型脊柱骨折。这使得手术团队能够在最小化主动脉损伤风险的同时实现脊柱复位。利用腘动脉通路可以在俯卧位时同时进行血管和脊柱介入治疗。结论复合REBOA和TEVAR为治疗严重移位的胸椎c型损伤提供了一种安全的策略，如果主动脉受伤或有继发性破裂的重大风险，即在重新定位操作期间。利用腘动脉的血管通路可以同时进行脊柱和微创血管手术。证据等级：V级——单例报告。

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引用次数: 0

Portal vein stenting for variceal bleeding at the choledochojejunostomy site in a patient with portal vein occlusion or stenosis: Report of two cases 门静脉支架置入术治疗胆道空肠造口处静脉曲张出血：附2例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-24 DOI: 10.1016/j.ijscr.2025.112068

Norifumi Iseda , Ryosuke Minagawa , Koichi Kimura , Terutoshi Yamaoka , Hironori Ochi , Takashi Nishizaki

Introduction

Gastrointestinal bleeding following hepato-biliary-pancreatic surgery may result from variceal hemorrhage at the choledochojejunostomy site due to portal vein (PV) stenosis. However, accurately determining the underlying cause can be difficult. Moreover, managing such bleeding can be challenging and even unsuccessful.

Presentation of case

Case 1: A 60-year-old man underwent pancreatoduodenectomy with PV resection and reconstruction for stage IB pancreatic cancer. Thirty-three months later, he developed variceal bleeding due to portal vein (PV) hypertension and bleeding from varices at the choledochojejunostomy site. PV stenting was performed using percutaneous transhepatic and trans-ileal approaches. No rebleeding occurred at 8 months.

Case 2: An 82-year-old man with recurrent hilar cholangiocarcinoma and PV stenosis developed variceal bleeding due to PV hypertension and variceal bleeding at the choledochojejunostomy site. After failed endoscopic therapy, PV stenting via the ileocolic vein was performed. He remained free from bleeding at 12 months.

Discussion

PV stenting can be effective for controlling bleeding from choledochojejunostomy varices caused by PV stenosis or occlusion. A bidirectional approach was essential in the occluded case. Literature review indicates high success rates. The need for antithrombotic therapy post-stenting remains unclear.

Conclusion

PV stenting is a feasible and effective option for variceal bleeding related to PV stenosis after pancreatoduodenectomy.

肝胆胰手术后的胃肠出血可能是由于门静脉狭窄导致的胆总管空肠吻合术部位的静脉曲张出血。然而，准确地确定潜在的原因可能很困难。此外，处理这种出血可能具有挑战性，甚至不成功。病例1：一名60岁男性因IB期胰腺癌行胰十二指肠切除术并PV切除术重建。33个月后，由于门静脉（PV）高压和胆肠吻合术部位的静脉曲张出血，他出现了静脉曲张出血。PV支架置入采用经皮、经肝和经回肠入路。8个月无再出血。病例2：一名82岁男性复发性肝门胆管癌和PV狭窄，由于PV高压和胆总管空肠吻合术部位的静脉曲张出血而发生静脉曲张出血。内镜治疗失败后，通过回结肠静脉进行PV支架置入。12个月时，他没有出血。讨论PV支架置入术可有效控制由PV狭窄或闭塞引起的胆总管空肠造口静脉曲张出血。在闭塞的情况下，双向入路是必不可少的。文献回顾表明成功率高。支架置入术后是否需要抗血栓治疗仍不清楚。结论胰十二指肠切除术后胰十二指肠管狭窄引起的静脉曲张出血是一种可行、有效的治疗方法。

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引用次数: 0

Merkel cell carcinoma of the parotid gland: a rare case report and literature review 腮腺默克尔细胞癌一例罕见病例报告及文献复习

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-24 DOI: 10.1016/j.ijscr.2025.112101

Pengfei Zhao , Shiyuan Liu , Tailiang Wu , Pengzhan Dai , Xiaoge Zhang , Wei Li

Introduction

Merkel cell carcinoma (MCC) is a rare and highly malignant neuroendocrine tumor. It typically manifests on the skin of the head, neck, and limbs. However, the primary MCC of the parotid gland is exceedingly rare, and the clinical diagnosis can be challenging.

Presentation of case

A 55-year-old female patient presented with a mass in the left parotid gland, with no evidence of other primary cutaneous lesions. Doppler ultrasound of the parotid gland revealed a solid hypoechoic lesion measuring approximately 22 × 16 mm. She underwent a left superficial parotidectomy under general anesthesia. Postoperative histopathological examination confirmed a diagnosis of primary Merkel cell carcinoma of the left parotid gland. No tumor recurrence was observed during the 10-month postoperative follow-up.

Discussion

Merkel carcinoma is a highly aggressive tumor with a very poor prognosis. Diagnosing Merkel carcinoma primarily relies on immunohistochemical techniques. The treatment for Merkel carcinoma mainly involves early and complete surgical resection, followed by postoperative adjuvant therapy. Currently, there are no pharmacological agents specifically approved for the treatment of Merkel cell carcinoma.

Conclusion

Primary Merkel carcinoma of the parotid gland is extremely rare. This case provides detailed clinical, histopathological, and therapeutic insights that may aid in improving early diagnosis and guiding effective surgical management. It also underscores the importance of vigilant postoperative follow-up to monitor for recurrence.

默克尔细胞癌（MCC）是一种罕见的高度恶性神经内分泌肿瘤。它通常表现在头部、颈部和四肢的皮肤上。然而，原发性腮腺MCC极为罕见，临床诊断具有挑战性。病例表现：一例55岁女性患者，左侧腮腺肿块，无其他原发性皮肤病变。腮腺多普勒超声显示一个实性低回声病灶，大小约为22 × 16毫米。她在全身麻醉下接受了左侧腮腺浅表切除术。术后病理检查证实为原发性左腮腺默克尔细胞癌。术后10个月随访未见肿瘤复发。默克尔癌是一种侵袭性很强的肿瘤，预后很差。诊断默克尔癌主要依靠免疫组织化学技术。默克尔癌的治疗主要是早期完全手术切除，术后辅助治疗。目前，还没有专门批准用于治疗默克尔细胞癌的药物。结论原发性腮腺默克尔癌极为罕见。本病例提供了详细的临床、组织病理学和治疗见解，可能有助于改善早期诊断和指导有效的外科治疗。这也强调了术后随访监测复发的重要性。

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引用次数: 0

Long-term survival, radiological, and histomorphological evaluation of hip resurfacing arthroplasty (HemiCAP) in the treatment of femoral head osteonecrosis: An 11-year follow-up case report 髋关节置换术（HemiCAP）治疗股骨头骨坏死的长期生存、放射学和组织形态学评估：11年随访病例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-24 DOI: 10.1016/j.ijscr.2025.112095

Onur Bilge , Muhammed Furkan Küçükşen , Mustafa Cihat Avunduk , Ülkü Kerimoğlu

Introduction and importance

To the best of our knowledge, the histomorphological and radiological evaluation and long-term survival of osseointegration of the HemiCAP® focal hip resurfacing system in the treatment of femoral head osteonecrosis have not previously been demonstrated. This study presents a case of a patient with femoral head osteonecrosis who underwent HemiCAP® resurfacing arthroplasty, followed by total hip arthroplasty (THA) after 11 years. Radiological and histomorphological assessments were performed on the removed implant. A review of relevant literature is also included.

Case presentation

A 54-year-old female with right femoral head osteonecrosis did not respond to three years of conservative treatment and core decompression. In 2013, she underwent HemiCAP® resurfacing. No complications such as subsidence, periprosthetic fracture, femoral neck narrowing, osteolysis, or prosthetic infection were observed over the 11-year follow-up. In 2024, THA was performed due to osteoarthritis progression. The explanted femoral head and implant were analyzed histomorphologically and radiologically.

Clinical discussion

This case demonstrates that the HemiCAP® implant achieved uneventful osseointegration over 11 years. These findings, supported by long-term radiological and histomorphometric evaluation, highlight the implant's potential value in joint-preserving surgeries in terms of long-term survival.

Conclusion

This case demonstrates that HemiCAP® resurfacing can provide 11-year implant survival without failure. To our knowledge, this is the first report evaluating both radiological and histological osseointegration of a HemiCAP® hip implant after long-term follow-up.

介绍和重要性据我们所知，HemiCAP®局灶性髋关节表面置换系统治疗股骨头坏死的组织形态学和放射学评估以及骨整合的长期生存期之前尚未得到证实。本研究报告了一例股骨头坏死患者，接受了HemiCAP®表面置换，并在11年后进行了全髋关节置换术（THA）。对取出的种植体进行放射学和组织形态学评估。对相关文献的回顾也包括在内。一例54岁女性右股骨头坏死患者，经三年保守治疗和股骨头减压治疗无效。2013年，她接受了HemiCAP®表面修复。在11年的随访中，未观察到塌陷、假体周围骨折、股骨颈狭窄、骨溶解或假体感染等并发症。2024年，由于骨关节炎进展，进行了THA手术。对取出的股骨头和假体进行组织形态学和放射学分析。本病例表明，HemiCAP®种植体在11年的时间里实现了平稳的骨整合。这些发现得到了长期放射学和组织形态学评估的支持，强调了植入物在长期存活方面在关节保护手术中的潜在价值。结论：本病例表明，HemiCAP®表面修复可以提供11年的种植体生存期。据我们所知，这是第一份评估长期随访后HemiCAP®髋关节植入物的放射学和组织学骨整合的报告。

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引用次数: 0

Successful rescue of the amputated glans penis placed as a composite graft and the application of continuous papaverine: A case report 复合植片成功抢救切除的龟头及连续罂粟碱的应用1例

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-24 DOI: 10.1016/j.ijscr.2025.112094

Serdar Nazif Nasır

Introduction and importance

Penile amputation is an uncommon condition reported globally as isolated cases or in small series. The leading cause of penile amputation is psychiatric disorders and self-amputation of external genitalia with hallucinations and delusions stemming from substance abuse. The chance of applying microsurgery is higher since self-mutilation in these cases occurs more frequently near the proximal part of the penis. In contrast, penile amputations caused by circumcision typically occur at the glans level, where microsurgical repair is usually not feasible. Therefore, utilizing a composite graft remains the only option.

Case presentation

We present a papaverine application protocol designed to enhance the neovascularization of the composite glans penis graft and maintain graft viability at the highest possible level.

Clinical discussion

Distal penile amputations remain surgically challenging. Composite grafting is reported for glans amputations; however, success rates are limited, and necrosis is a common complication. In our case, the use of topical papaverine may have supported neovascularization and graft survival. Additionally, penile amputation cases due to circumcision in the English and non-English literature are reviewed.

Conclusion

Composite grafting is the only feasible option for distal penile amputations. Topical papaverine can increase neovascularization, thereby minimizing graft loss, especially in thick tissues such as composite grafts, although larger clinical studies are needed to validate its efficacy.

介绍和重要性阴茎截肢是一种罕见的疾病，在全球范围内报道为孤立病例或小系列病例。阴茎截肢的主要原因是精神疾病和自我外生殖器截肢，并伴有药物滥用引起的幻觉和妄想。应用显微手术的机会更高，因为在这些情况下，自残更频繁地发生在阴茎近端附近。相比之下，包皮环切引起的阴茎截肢通常发生在龟头水平，显微手术修复通常是不可行的。因此，使用复合移植物仍然是唯一的选择。我们提出了一种罂粟碱应用方案，旨在增强复合阴茎头移植物的新生血管，并保持移植物在最高水平的活力。阴茎远端截肢手术仍然具有挑战性。复合移植术被报道用于龟头截肢；然而，手术成功率有限，坏死是常见的并发症。在我们的病例中，局部使用罂粟碱可能支持新生血管和移植物存活。此外，阴茎截肢的情况下，由于包皮环切在英语和非英语文献回顾。结论复合植骨是阴茎远端截肢唯一可行的方法。局部罂粟碱可以增加新生血管，从而最大限度地减少移植物损失，特别是在厚组织中，如复合移植物，尽管需要更大规模的临床研究来验证其有效性。

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引用次数: 0

Delayed presentation of infantile hypertrophic pyloric stenosis: a case report 婴儿肥厚性幽门狭窄延迟表现1例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-24 DOI: 10.1016/j.ijscr.2025.112092

Goytoom Kahsay Berhe , Reiye Esayas Mengesha , Hadush Tesfay Negash , Yirgalem Teklebirhan Gereziher , Teklit GebremedhinTeklu

Introduction and importance

Hypertrophic pyloric stenosis (HPS) is characterized by hyperplasia of the smooth muscle fibers of the pylorus, leading to narrowing of the pyloric canal and obstruction of gastric emptying. It is the most common cause of surgical vomiting in infants. Classically, infants present with non-bilious projectile vomiting; the child is hungry after vomiting and suckles well but becomes dehydrated and wasted. IHPS usually presents between the 3rd and 5th weeks of life. Cases of delayed presentation are very rare (1/100,000) and usually diagnosis is delayed. We are reporting atypically late age presentation of infantile hypertrophic pyloric stenosis case.

Case presentation

We report the case of a 10-month-old male infant who presented with non-bilious vomiting of nine months' duration. On examination, he was wasted and stunted, with no palpable “olive.” Abdominal ultrasound revealed a hypertrophied pyloric muscle. A diagnosis of hypertrophic pyloric stenosis was made, and Ramstedt's pyloromyotomy was performed. The infant resumed feeding eight hours postoperatively, with no recurrence of vomiting.

Discussion

Infantile hypertrophic pyloric stenosis (IHPS) results from hypertrophy and hyperplasia of the circular muscle fibers of the pylorus, causing progressive narrowing of the gastric outlet and subsequent obstruction. It is one of the most common causes of non-bilious, projectile vomiting in infants, typically presenting between the second and eighth weeks of life. Aboagye et al. reported that 97.5 % of IHPS cases are diagnosed by 12 weeks of age, with a peak at around five weeks. Presentation beyond this window is unusual and often leads to diagnostic delays.

Conclusion

Delayed presentation of infantile hypertrophic pyloric stenosis is uncommon but critical to recognize. Clinicians should maintain a high index of suspicion for IHPS in infants with persistent vomiting, even beyond the typical age range. Early diagnosis and timely surgical intervention are essential to prevent complications and ensure favorable outcomes. This case highlights the importance of recognizing atypical presentations to avoid diagnostic delays.

简介及重要性肥厚性幽门狭窄（HPS）的特点是幽门平滑肌纤维增生，导致幽门管狭窄和胃排空阻塞。这是婴儿手术呕吐最常见的原因。典型地，婴儿表现为非胆汁性抛射性呕吐；孩子在呕吐后感到饥饿，吃奶很好，但会脱水和消瘦。IHPS通常出现在生命的第三到第五周之间。延迟表现的病例非常罕见（1/100,000），通常诊断延迟。我们在此报告一例婴幼儿肥厚性幽门狭窄的非典型晚期表现。我们报告了一个10个月大的男婴，他表现为9个月的非胆汁性呕吐。经检查，他消瘦、发育不良，没有明显的“橄榄枝”。腹部超声显示幽门肌肥大。诊断为肥厚性幽门狭窄，并行Ramstedt幽门切开术。婴儿术后8小时恢复喂养，无呕吐复发。婴儿肥厚性幽门狭窄（IHPS）是幽门环状肌纤维肥大和增生的结果，引起胃出口进行性狭窄和随后的梗阻。它是婴儿非胆汁性抛射性呕吐的最常见原因之一，通常出现在生命的第二和第八周之间。Aboagye等人报道，97.5%的IHPS病例在12周龄时被诊断出来，在5周龄左右达到高峰。超出这个窗口的表现是不寻常的，经常导致诊断延迟。结论小儿肥厚性幽门狭窄的迟发性表现并不常见，但鉴别十分重要。对于持续呕吐的婴儿，临床医生应保持对IHPS的高度怀疑，即使超出了典型的年龄范围。早期诊断和及时的手术干预对预防并发症和确保良好的预后至关重要。本病例强调了识别非典型表现以避免诊断延误的重要性。

{"title":"Delayed presentation of infantile hypertrophic pyloric stenosis: a case report","authors":"Goytoom Kahsay Berhe , Reiye Esayas Mengesha , Hadush Tesfay Negash , Yirgalem Teklebirhan Gereziher , Teklit GebremedhinTeklu","doi":"10.1016/j.ijscr.2025.112092","DOIUrl":"10.1016/j.ijscr.2025.112092","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Hypertrophic pyloric stenosis (HPS) is characterized by hyperplasia of the smooth muscle fibers of the pylorus, leading to narrowing of the pyloric canal and obstruction of gastric emptying. It is the most common cause of surgical vomiting in infants. Classically, infants present with non-bilious projectile vomiting; the child is hungry after vomiting and suckles well but becomes dehydrated and wasted. IHPS usually presents between the 3rd and 5th weeks of life. Cases of delayed presentation are very rare (1/100,000) and usually diagnosis is delayed. We are reporting atypically late age presentation of infantile hypertrophic pyloric stenosis case.</div></div><div><h3>Case presentation</h3><div>We report the case of a 10-month-old male infant who presented with non-bilious vomiting of nine months' duration. On examination, he was wasted and stunted, with no palpable “olive.” Abdominal ultrasound revealed a hypertrophied pyloric muscle. A diagnosis of hypertrophic pyloric stenosis was made, and Ramstedt's pyloromyotomy was performed. The infant resumed feeding eight hours postoperatively, with no recurrence of vomiting.</div></div><div><h3>Discussion</h3><div>Infantile hypertrophic pyloric stenosis (IHPS) results from hypertrophy and hyperplasia of the circular muscle fibers of the pylorus, causing progressive narrowing of the gastric outlet and subsequent obstruction. It is one of the most common causes of non-bilious, projectile vomiting in infants, typically presenting between the second and eighth weeks of life. Aboagye et al. reported that 97.5 % of IHPS cases are diagnosed by 12 weeks of age, with a peak at around five weeks. Presentation beyond this window is unusual and often leads to diagnostic delays.</div></div><div><h3>Conclusion</h3><div>Delayed presentation of infantile hypertrophic pyloric stenosis is uncommon but critical to recognize. Clinicians should maintain a high index of suspicion for IHPS in infants with persistent vomiting, even beyond the typical age range. Early diagnosis and timely surgical intervention are essential to prevent complications and ensure favorable outcomes. This case highlights the importance of recognizing atypical presentations to avoid diagnostic delays.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"137 ","pages":"Article 112092"},"PeriodicalIF":0.7,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Local soft tissue dissemination of large joint septic arthritis: A report of two cases 大关节化脓性关节炎局部软组织播散2例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-24 DOI: 10.1016/j.ijscr.2025.112098

Ojochonu David Anthony , Jevan Cevik JC , Nelson Low NL

Introduction

Septic arthritis (SA) is a surgical emergency that can result in joint destruction and systemic sepsis. Local soft tissue dissemination of native joint SA leading to necrotising fasciitis (NF) is a rare but devastating complication associated with poorer outcomes.

Case presentation

We present two adult patients with poorly controlled diabetes who developed SA complicated by NF—one affecting the knee and posterior leg, the other the shoulder and anterior arm. Both required multiple joint washouts, serial wound debridements, intensive care unit (ICU) admission, and prolonged intravenous antibiotics. One patient sustained extensive soft tissue loss necessitating coverage with a biodegradable temporising matrix (BTM) followed by split-thickness skin grafting.

Clinical discussion

These cases highlight the clinical course of this rare but severe complication and emphasise the importance of early diagnosis, initiation of broad-spectrum intravenous antibiotics, and timely surgical intervention. We also outline a practical diagnostic and management framework, including antimicrobial selection post-arthrocentesis, the role of pre-operative imaging, and the rationale for selecting arthroscopic versus open joint debridement.

Conclusion

SA complicated by NF is a life- and limb-threatening condition that presents numerous diagnostic and therapeutic challenges. Early recognition and a multidisciplinary approach incorporating empirical antibiotics, targeted imaging, and prompt surgical management are essential to optimise outcomes.

脓毒性关节炎（SA）是一种外科急症，可导致关节破坏和全身败血症。局部软组织播散导致关节SA坏死性筋膜炎（NF）是一种罕见但毁灭性的并发症，预后较差。我们报告了2例控制不良的糖尿病患者并发SA合并nf， 1例累及膝关节和后腿，另1例累及肩部和前臂。两者都需要多次关节冲洗、连续伤口清创、重症监护病房（ICU）住院和长时间静脉注射抗生素。一名患者持续广泛的软组织丢失，需要用可生物降解的临时基质（BTM）覆盖，然后进行分厚皮肤移植。这些病例强调了这种罕见但严重并发症的临床病程，并强调了早期诊断、开始使用广谱静脉注射抗生素和及时手术干预的重要性。我们还概述了一个实用的诊断和管理框架，包括关节穿刺后抗菌药物的选择，术前成像的作用，以及选择关节镜与开放式关节清创的基本原理。结论sa合并NF是一种危及生命和肢体的疾病，对诊断和治疗提出了许多挑战。早期识别和多学科方法结合经验性抗生素，靶向成像和及时手术治疗是优化结果的必要条件。

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引用次数: 0