International Journal of Surgery Case Reports最新文献_第9页

Management challenges of advanced colorectal cancer in a young adult from a low-resource setting: A case report 来自低资源环境的年轻成人晚期结直肠癌的管理挑战：一个病例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-24 DOI: 10.1016/j.ijscr.2025.112099

Agathon Avelin Kimario , Alfred Kishe , Benardine P. Mallilah , Joel Pilot Mushi , Rehema Enock Sovela , Alex Mremi

Introduction and importance

Colorectal cancer (CRC) is traditionally considered a disease of older adults; however, the incidence of young-onset colorectal cancer (YOCRC) is steadily increasing worldwide. This trend presents diagnostic and therapeutic challenges, particularly in resource-limited settings where awareness and screening programs are often lacking.

Case presentation

We report the case of a 26-year-old male with a three-year history of vague abdominal symptoms, including intermittent pain, bloating, and altered bowel habits. Despite multiple healthcare visits, the underlying pathology remained undiagnosed until he presented with acute intestinal obstruction. Emergency exploratory laparotomy revealed an advanced colonic mass. Histopathological examination confirmed the diagnosis of moderately differentiated adenocarcinoma of the colon, staged as pT3N2Mx.

Clinical discussion

This case highlights the diagnostic challenges of YOCRC, which often presents with nonspecific symptoms and is underestimated in younger populations. In low-resource environments, limited access to diagnostic modalities and low clinical suspicion contribute to frequent misdiagnoses and delayed detection, resulting in presentation at advanced stages and reduced chances for curative treatment.

Conclusion

This report emphasizes the need for heightened clinical suspicion of colorectal cancer in younger patients presenting with persistent gastrointestinal complaints, highlights the importance of timely access to diagnostic tools to reduce delays in care, and underscores the public health value of awareness campaigns and consideration of earlier screening to address the rising burden of YOCRC.

传统上认为，结直肠癌（CRC）是老年人的一种疾病；然而，在世界范围内，年轻发病的结直肠癌（YOCRC）的发病率正在稳步上升。这一趋势给诊断和治疗带来了挑战，特别是在资源有限的环境中，人们往往缺乏认识和筛查计划。我们报告一个26岁的男性病例，他有三年的模糊腹部症状史，包括间歇性疼痛、腹胀和排便习惯改变。尽管多次就诊，潜在的病理仍未确诊，直到他提出急性肠梗阻。紧急剖腹探查术发现晚期结肠肿块。组织病理学检查证实为结肠中分化腺癌，分期为pT3N2Mx。该病例突出了YOCRC的诊断挑战，它通常表现为非特异性症状，并且在年轻人群中被低估。在资源匮乏的环境中，获得诊断方式的机会有限，临床怀疑程度低，导致经常误诊和延误发现，导致在晚期出现症状，减少了治愈治疗的机会。结论本报告强调了有持续性胃肠道疾患的年轻患者需要提高对结直肠癌的临床怀疑，强调了及时获得诊断工具以减少护理延误的重要性，并强调了提高认识运动和考虑早期筛查以解决YOCRC日益增加的负担的公共卫生价值。

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引用次数: 0

Paradoxical ileocecal perforation during early anti-tuberculosis therapy: A rare case report 早期抗结核治疗中的回盲穿孔：一例罕见病例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-24 DOI: 10.1016/j.ijscr.2025.112100

Yoseph Mulatu Habte , Binyam Mulatu Habte , Yabetse Alemayehu Kifle , Esimael Musema Abdu , Makida Mulatu Habte , Shimelis Ayalew Yimer

Introduction and importance

Tuberculosis remains a global health challenge, with extrapulmonary forms accounting for a significant proportion of cases. Intestinal tuberculosis, though uncommon, can present with nonspecific gastrointestinal symptoms and lead to severe complications, including intestinal perforation.

Presentation of case

We report a 24-year-old male with a two-year history of right lower quadrant abdominal pain, weight loss, and anorexia. Imaging and colonoscopy revealed ileocecal thickening with ulceration and stenosis; biopsies confirmed tuberculous enteritis. Six days after starting anti-tubercular therapy, he developed generalized peritonitis due to an ileocecal perforation. Right hemicolectomy with ileotransverse anastomosis was performed. He received postoperative antibiotics, analgesics, and continued anti-tubercular therapy, with good recovery on follow-up.

Discussion

Paradoxical intestinal perforation during anti-tubercular therapy is a rare but serious complication, likely due to a delayed hypersensitivity reaction to mycobacterial antigens, particularly in the ileocecal region. It may mimic treatment failure, delaying intervention. Prompt surgical management, continued anti-tubercular therapy, and high clinical suspicion during early treatment are vital to reduce morbidity and improve patient prognosis.

Conclusion

This case highlights the importance of recognizing paradoxical reactions, such as intestinal perforation, as potential complications during the early phase of anti-tubercular therapy. Maintaining early vigilance and a high index of suspicion is essential for timely diagnosis and appropriate intervention. Clinicians should consider paradoxical perforation in patients who deteriorate shortly after initiating anti-TB treatment, even when adherence is confirmed. Early surgical intervention, guided by a high index of suspicion, is crucial to reducing morbidity and improving outcomes in intestinal tuberculosis.

结核病仍然是一个全球性的健康挑战，肺外形式占病例的很大比例。肠结核虽然不常见，但可出现非特异性胃肠道症状并导致严重并发症，包括肠穿孔。我们报告一名24岁男性，有两年的右下腹腹痛、体重减轻和厌食症病史。影像学和结肠镜检查显示回盲增厚伴溃疡和狭窄；活检证实为结核性肠炎。开始抗结核治疗6天后，患者因回盲穿孔而出现全身性腹膜炎。行右半结肠切除术并回肠横切吻合。术后给予抗生素、镇痛药及持续抗结核治疗，随访恢复良好。在抗结核治疗过程中，矛盾肠穿孔是一种罕见但严重的并发症，可能是由于对分枝杆菌抗原的延迟超敏反应，特别是在回盲区。它可能模仿治疗失败，延迟干预。及时的手术治疗，持续的抗结核治疗，以及在早期治疗时高度的临床怀疑对降低发病率和改善患者预后至关重要。结论本病例强调了在抗结核治疗早期识别肠穿孔等矛盾反应作为潜在并发症的重要性。保持早期警惕和高度怀疑对于及时诊断和适当干预至关重要。临床医生应考虑在开始抗结核治疗后不久病情恶化的患者的矛盾穿孔，即使已确认坚持治疗。在高度怀疑的指导下，早期手术干预对于降低发病率和改善肠结核的预后至关重要。

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引用次数: 0

Strongyloides stercoralis infection presenting as a surgical diagnosis, a rare but important consideration: Case series of two patients 粪类圆线虫感染表现为外科诊断，罕见但重要的考虑：两个病人的病例系列

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-23 DOI: 10.1016/j.ijscr.2025.112090

Martin Infante Altamirano , Akshat Sanan , Gustavo A. Rubio , Henry J. Lujan

Introduction

Strongyloides stercoralis (S. stercoralis), is a parasitic helminth with variable gastrointestinal symptoms that can mimic inflammatory bowel disease or malignancy. Diagnosis is often delayed due to nonspecific presentation and low test sensitivity, especially in non-endemic areas.

Methods

We reviewed two cases of S. stercoralis infection presenting as chronic colitis. Clinical, endoscopic, and histologic findings were analyzed, and diagnosis was confirmed via serology testing.

Results

Both patients presented with chronic abdominal pain and colitis on image test. Serological tests revealed immune responses consistent with S. stercoralis infection. One patient had a history of travel to an endemic area; the other had chronic alcohol use. Symptoms resolved with antiparasitic therapy.

Conclusion

S. stercoralis infection can produce chronic colitis and lead to misdiagnosis. Awareness of risk factors and histologic features is essential to avoid unnecessary surgical intervention.

肠类圆线虫（S. stercoralis）是一种具有多种胃肠道症状的寄生虫，可模仿炎症性肠病或恶性肿瘤。由于非特异性表现和低检测灵敏度，特别是在非流行地区，诊断常常被延迟。方法回顾性分析2例以慢性结肠炎为临床表现的粪球菌感染病例。对临床、内窥镜和组织学结果进行分析，并通过血清学检测确诊。结果两例患者影像学检查均表现为慢性腹痛和结肠炎。血清学试验显示免疫反应与粪球菌感染一致。1例患者有去过流行地区的旅行史；另一组长期饮酒。抗寄生虫治疗后症状得到缓解。粪虫感染可引起慢性结肠炎并导致误诊。了解危险因素和组织学特征对于避免不必要的手术干预至关重要。

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引用次数: 0

Sagittal biplanar ‘L’-shaped tibial osteotomy associated with osteochondral allograft for symptomatic varus knee and low patella 矢状双平面“L”形胫骨截骨联合同种异体骨软骨移植治疗症状性膝内翻和低髌骨

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-21 DOI: 10.1016/j.ijscr.2025.112074

Eliseo Javier Firman , Eduardo Manuel Río , Adrián Nicolás Sirio

Introduction

The “L”-shaped tibial osteotomy is a relatively recent surgical technique aimed at correcting the mechanical axis without altering patellar height or posterior tibial slope (common complications associated with conventional medial opening wedge osteotomies).

Case presentation

We report the case of a young patient with symptomatic genu varum, osteochondral lesion in the medial femoral condyle, and low patellar height. A sagittal biplanar “L”-shaped proximal tibial osteotomy was performed, fixed with a Puddu plate and two anteroposterior screws. The osteotomy gap was filled with non-irradiated morselized bone allograft to promote consolidation. Additionally, a fresh osteochondral allograft transplant was carried out in the same surgical procedure.

Clinical discussion

This technique allows for multiplanar correction while avoiding the increase in posterior tibial slope or reduction in patellar height, commonly seen with standard approaches. In our experience, combining dual anteroposterior screw fixation, morselized allograft, and osteochondral transplantation in a single stage resulted in improved mechanical stability, early bone integration, and satisfactory functional recovery.

Conclusion

The biplanar “L”-shaped tibial osteotomy offers a theoretical biomechanical advantage by enabling coronal correction without altering the posterior tibial slope or patellar height in the sagittal plane. In this case, it allowed simultaneous management of the deformity and the osteochondral lesion in a single-stage procedure. However, as this is a single case, the results should be interpreted with caution and require confirmation through larger series with long-term follow-up.

“L”型胫骨截骨术是一种相对较新的手术技术，旨在纠正机械轴而不改变髌骨高度或胫骨后坡（常规内侧开口楔形截骨术的常见并发症）。我们报告一例年轻的膝内翻症状，股骨内侧髁骨软骨病变，髌骨高度低的病例。行矢状双平面“L”形胫骨近端截骨术，用Puddu钢板和两枚前后螺钉固定。用未辐照的同种异体块状骨移植物填充截骨间隙以促进巩固。此外，在相同的手术过程中进行了新鲜骨软骨移植。该技术允许多平面矫正，同时避免标准入路常见的胫骨后坡增加或髌骨高度降低。根据我们的经验，单期联合双前后位螺钉固定、碎片化同种异体移植物和骨软骨移植可改善机械稳定性、早期骨整合和令人满意的功能恢复。结论双平面“L”型胫骨截骨术具有理论上的生物力学优势，可以在不改变胫骨后坡或矢状面髌骨高度的情况下进行冠状面矫正。在这种情况下，它允许在单阶段手术中同时处理畸形和骨软骨病变。然而，由于这是一个单一的病例，结果应谨慎解释，需要通过更大的系列和长期随访来确认。

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引用次数: 0

Robotic subtotal gastrectomy with Hugo™ robotic-assisted surgery (RAS) system: first report on a case series 采用Hugo™机器人辅助手术（RAS）系统的机器人胃次全切除术：首例病例系列报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-21 DOI: 10.1016/j.ijscr.2025.112085

R. Cammarata , V. La Vaccara , A. Catamerò , R. Coppola , D. Caputo

Introduction

Robotic-assisted surgery (RAS) has increasingly gained interest in gastric cancer treatment due to its enhanced precision and vision. Hugo™ RAS is a novel system designed to improve accessibility and reduce costs. However, its use in oncologic upper gastrointestinal procedures is still scarcely documented.

Presentation of case

We report four consecutive cases of subtotal gastrectomy with D2 lymphadenectomy performed using Hugo™ RAS at a single institution. Patients were selected following multidisciplinary evaluation and underwent full robotic procedures with standardized port placements. Intraoperative parameters, complications, and short-term oncologic outcomes were analyzed.

Discussion

All procedures were completed successfully without conversion or major complications. Median docking and console times were within acceptable limits, though longer than traditional laparoscopy due to system learning curve and intraoperative frozen section use. Lymphadenectomy was adequate in all D2 cases with R0 resection achieved. No blood transfusions were needed. Postoperative complications included delayed gastric emptying and a duodenal stump leak. The system proved safe, and the procedural setup did not require modifications from laparoscopic standards.

Conclusion

Subtotal gastrectomy with D2 lymphadenectomy using Hugo™ RAS is feasible and safe. The standardized setup and available instruments support oncologic adequacy without energy devices. Further studies are needed to validate long-term outcomes and assess comparative advantages over conventional approaches.

机器人辅助手术（RAS）由于其精度和视力的提高，在胃癌治疗中越来越受到关注。Hugo™RAS是一种新颖的系统，旨在提高可及性并降低成本。然而，其在肿瘤上消化道手术中的应用仍鲜有文献记载。我们报告了在同一机构使用Hugo™RAS进行的连续四例胃大部切除术合并D2淋巴结切除术。患者在多学科评估后选择，并进行了标准化端口放置的全机器人手术。分析术中参数、并发症和短期肿瘤预后。所有手术均成功完成，无转归或重大并发症。中位对接和控制台时间在可接受范围内，尽管由于系统学习曲线和术中冷冻切片的使用，比传统腹腔镜更长。所有D2病例均行淋巴结切除术，均达到R0切除。不需要输血。术后并发症包括胃排空延迟和十二指肠残端漏。该系统被证明是安全的，并且程序设置不需要根据腹腔镜标准进行修改。结论采用Hugo™RAS进行胃大部切除术并D2淋巴结切除术是可行且安全的。标准化的设置和可用的仪器支持肿瘤充分性，无需能源设备。需要进一步的研究来验证长期结果并评估与传统方法相比的比较优势。

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引用次数: 0

Long-standing neck mass: A rare case of vagal paraganglioma 长期颈部肿块：一例罕见的迷走副神经节瘤

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-20 DOI: 10.1016/j.ijscr.2025.112055

Maryam Sadiq , Sarmad Ali , Awais Tariq , Junaid Azad , Jahangir Sarwar Khan

Introduction

Vagal paragangliomas (VPG) are rare, slow-growing tumors of the head and neck, often asymptomatic but can present as progressively enlarging neck masses. These tumors are predominantly benign but have the potential for malignant behavior in a small percentage of cases. Diagnosis typically involves clinical examination, imaging studies, and fine needle aspiration cytology (FNAC). Surgical excision remains the treatment of choice for large, resectable masses.

Case presentation

We report a case of a 55-year-old female with a long-standing, gradually enlarging, painless right-sided neck mass. The mass had been present for 10 years, with no associated symptoms of catecholamine hypersecretion. Examination revealed a large, non-lobulated swelling. FNAC and imaging, including ultrasound and contrast-enhanced CT, confirmed the diagnosis of vagal paraganglioma. The patient underwent successful surgical excision with minimal postoperative complications and was discharged on the third postoperative day.

Discussion

Vagal paragangliomas typically present as neck masses and may lead to cranial nerve dysfunction. Imaging modalities such as CT, MRI, and angiography are essential for diagnosis and surgical planning. Surgical excision remains the primary treatment, though nerve-sparing procedures are uncommon and carry a risk of postoperative cranial nerve deficits. In our case, recovery was favorable, but such outcomes should be interpreted with caution given the potential for complications reported in the literature.

Conclusion

This case highlights the importance of considering vagal paragangliomas in the differential diagnosis of neck masses. Diagnosis relies on careful clinical evaluation and imaging, while surgical excision remains the mainstay of treatment for resectable lesions. Although our patient's recovery was favorable, potential cranial nerve and vascular complications should be anticipated. Further research and genetic studies are needed to better define long-term outcomes and management strategies.

迷走副神经节瘤（VPG）是一种罕见的、生长缓慢的头颈部肿瘤，通常无症状，但可表现为逐渐增大的颈部肿块。这些肿瘤主要是良性的，但在一小部分病例中有潜在的恶性行为。诊断通常包括临床检查、影像学检查和细针穿刺细胞学检查（FNAC）。对于可切除的大肿块，手术切除仍然是治疗的选择。我们报告一例55岁女性，右侧颈部长有逐渐增大的无痛性肿块。肿块已经存在了10年，没有儿茶酚胺分泌过多的相关症状。检查发现一个大的非分叶性肿胀。FNAC及影像学包括超声和增强CT证实迷走神经节瘤的诊断。患者手术切除成功，术后并发症极少，于术后第三天出院。迷走神经副神经节瘤通常表现为颈部肿块，可导致脑神经功能障碍。成像方式，如CT， MRI和血管造影是必不可少的诊断和手术计划。手术切除仍然是主要的治疗方法，尽管保留神经的手术并不常见，并且有术后颅神经缺损的风险。在我们的病例中，恢复是有利的，但考虑到文献中报道的潜在并发症，这样的结果应该谨慎解释。结论本病例强调迷走神经副神经节瘤在颈部肿块鉴别诊断中的重要性。诊断依赖于仔细的临床评估和成像，而手术切除仍然是治疗可切除病变的主要方法。虽然我们的病人恢复良好，但潜在的脑神经和血管并发症应该预料到。需要进一步的研究和基因研究来更好地确定长期结果和管理策略。

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引用次数: 0

Vasovagal syncope during ultrasound-guided internal jugular vein cannulation: A case report 超声引导下颈内静脉插管时血管迷走神经性晕厥1例

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-20 DOI: 10.1016/j.ijscr.2025.112083

Xiulian Wang , Qing Sun , Guopeng Deng , Xiaopeng Wang

Introduction

Vasovagal syncope (VVS) is a reflex syncope caused by excessive vagal activation and sympathetic inhibition, primarily manifesting as bradycardia, hypotension, and transient loss of consciousness. Although reports of VVS during ultrasound-guided internal jugular vein catheterization are rare, failure to actively identify and manage this condition may increase the risk of adverse events, warranting high clinical vigilance.

Presentation of case

This paper describes a middle-aged male patient who experienced sudden VVS during ultrasound-guided right internal jugular vein catheterization. The patient presented with abrupt loss of consciousness, pallor, profuse sweating, and a rapid drop in heart rate and blood pressure. Immediate cessation of the procedure, rapid fluid resuscitation, and ephedrine administration led to prompt recovery.

Discussion

After the patient's vital signs stabilized, the relevant causes were actively differentiated, and after excluding hypoglycemia, cardiogenic syncope, local anesthetic poisoning, neurofunctional syncope and other causes, the cause of VVS was determined, and the mechanism of VVS was retrospectively analyzed, and the prevention and treatment measures for VVS were improved.

Conclusion

This case highlights the importance of identifying and emergency management of VVS during ultrasound-guided internal jugular venous venous catheterization and discusses related prevention strategies.

血管迷走神经性晕厥（VVS）是一种由迷走神经过度激活和交感神经抑制引起的反射性晕厥，主要表现为心动过缓、低血压和短暂性意识丧失。虽然在超声引导下颈内静脉置管过程中出现VVS的报道很少，但如果不能积极识别和处理这种情况，可能会增加不良事件的风险，需要高度的临床警惕。本文报告一位中年男性患者在超声引导下行右颈内静脉置管时突然发生VVS。患者表现为突然失去意识，脸色苍白，大量出汗，心率和血压迅速下降。立即停止手术，快速液体复苏和麻黄素治疗使患者迅速恢复。在患者生命体征稳定后，积极鉴别相关病因，排除低血糖、心源性晕厥、局麻中毒、神经功能性晕厥等原因后，确定VVS的病因，并回顾性分析VVS的发病机制，完善VVS的防治措施。结论本病例强调超声引导颈内静脉置管术中VVS的识别和急诊处理的重要性，并探讨了相关的预防策略。

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引用次数: 0

Whipple procedure for duodenal gastrointestinal stromal tumors: A report of two cases 惠普尔手术治疗十二指肠胃肠道间质瘤附2例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-17 DOI: 10.1016/j.ijscr.2025.112078

Samir Nasser , Abdel Rahman Abu Hilal , Younis Abu Helal , Lila H. Abu-Hilal , Yumna Njoum , Omar AbuZaydeh

Introduction and importance

Gastrointestinal stromal tumors (GIST) are rare neoplasms that can grow anywhere along the GI tract. They comprise only 0.1 % to 3 % of all gastrointestinal tumors, and approximately 30 % of GISTs are malignant. They exhibit variable clinical presentations, ranging from incidental findings to symptomatic presentations such as gastrointestinal bleeding, abdominal pain, abdominal mass, or obstruction. Duodenal gastrointestinal stromal tumors are among the rarest subtypes, accounting for less than 4 % of all GISTs but up to 21 % of the resected ones.

Case presentation

We report two cases of duodenal GIST (dGIST) treated with the Whipple procedure. The first patient, a 73- year old woman, presented with dizziness, and lightheadedness. The patient had severe anemia requiring blood transfusions. Imaging revealed a mass with fistula formation. Subsequent endoscopy with biopsy confirmed the diagnosis of GIST. The second patient, a 48-year-old woman, presented with lightheadedness, melena and epigastric abdominal pain. Laboratory investigations revealed severe anemia. Urgent upper endoscopy revealed an ulcerated submucosal duodenal mass. Imaging demonstrated mass near the junction of the second and third part of the duodenum.

Clinical discussion

The surgical approach for GIST is usually influenced by tumor size, site, histopathological findings and overall risk assessment. Nevertheless, unlike other subtypes of GISTs, surgical management of duodenal GISTs poses unique challenges due to ongoing controversies regarding the most appropriate surgical approach.

Conclusion

Diagnosis of GIST can be challenging and is usually influenced by the presenting symptoms. The cornerstone of management in GIST is complete tumor resection with negative margins.

胃肠道间质瘤（GIST）是一种罕见的肿瘤，可以生长在胃肠道的任何地方。它们仅占所有胃肠道肿瘤的0.1%至3%，约30%的胃肠道间质瘤是恶性的。它们表现出不同的临床表现，从偶然发现到症状表现，如胃肠道出血、腹痛、腹部肿块或梗阻。十二指肠胃肠道间质瘤是最罕见的亚型之一，占所有胃肠道间质瘤的不到4%，但占切除肿瘤的21%。我们报告两例十二指肠间质瘤（dGIST）采用惠普尔手术治疗。第一位患者是一位73岁的女性，表现为头晕和头昏。病人有严重的贫血，需要输血。影像学显示肿块伴瘘管形成。随后的内镜活检证实了GIST的诊断。第二例患者为48岁女性，表现为头晕、黑黑和上腹部疼痛。实验室检查显示严重贫血。紧急上腔镜检查显示一溃疡性十二指肠粘膜下肿块。影像学显示肿块位于十二指肠第二和第三部分交界处附近。GIST的手术入路通常受肿瘤大小、部位、组织病理学表现和总体风险评估的影响。然而，与其他胃肠道间质瘤亚型不同，十二指肠胃肠道间质瘤的手术治疗面临着独特的挑战，因为关于最合适的手术入路的争议一直存在。结论胃肠道间质瘤的诊断具有挑战性，通常受症状的影响。GIST治疗的基石是完全切除阴性切缘的肿瘤。

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引用次数: 0

Redo aortic valve replacement in twin pregnancy: navigating high-risk cardiac surgery with maternal and fetal success – A case report 双胎妊娠重做主动脉瓣置换术：引导高危心脏手术与母体和胎儿成功- 1例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-17 DOI: 10.1016/j.ijscr.2025.112070

Syed Shamair Ali Rizvi , Muhammad Nabeel Safdar , Sara Iqbal , Farhala Baloch , Shazia Masheer , Syed Shahabuddin

Introduction and importance

Redo aortic valve replacement (AVR) in pregnancy presents significant challenges due to maternal hemodynamics, fetal well-being, and anticoagulation management. Prosthetic valve stenosis is a life-threatening condition and can significantly alter the maternal and fetal outcome without treatment. We report a case of a pregnant woman with twin gestation who developed prosthetic valve stenosis due to pannus formation and requiring redo AVR.

Case presentation

A 31-year-old woman, pregnant with dichorionic diamniotic twins at 14 weeks, presented with worsening dyspnea. She had undergone mechanical AVR at 11 years of age and was on warfarin; however, she stopped taking warfarin since 2014. Echocardiography revealed prosthetic aortic valve stenosis, with severely elevated transvalvular gradients. She underwent redo AVR with a 21 mm On-X mechanical valve following aortic root enlargement. Postoperatively, she developed complete atrioventricular dissociation, requiring a permanent pacemaker. Multidisciplinary care ensured fetal viability, and she was discharged in stable condition with appropriate anticoagulation management.

Discussion

Redo AVR during pregnancy requires meticulous planning, balancing maternal and fetal risks. This case highlights the complexities of anticoagulation strategies, surgical execution, and maternal-fetal monitoring.

Conclusion

A multidisciplinary approach is essential to optimize outcomes in pregnant patients undergoing redo AVR. Long-term follow-up is crucial for continued surveillance of prosthetic valve function and maternal health.

由于母体血流动力学、胎儿健康和抗凝管理，妊娠期主动脉瓣置换术（AVR）面临重大挑战。人工瓣膜狭窄是一种危及生命的疾病，如果不进行治疗，可以显著改变母体和胎儿的结局。我们报告了一例双胎妊娠的孕妇，由于输卵管形成而发展了人工瓣膜狭窄，需要重新进行AVR。病例表现：一名31岁女性，14周时怀双绒毛膜双羊膜双胞胎，表现为呼吸困难加重。她在11岁时接受了机械AVR，并服用华法林；然而，她从2014年开始停止服用华法林。超声心动图显示人工主动脉瓣狭窄，经瓣梯度严重升高。在主动脉根部扩大后，她接受了21mm On-X机械瓣膜的重做AVR。术后，患者出现完全房室分离，需要永久性起搏器。多学科的护理确保了胎儿的生存能力，她出院时病情稳定，并进行了适当的抗凝治疗。妊娠期再做AVR需要周密的计划，平衡母体和胎儿的风险。本病例强调抗凝策略、手术执行和母胎监测的复杂性。结论多学科联合治疗是优化妊娠再行AVR预后的关键。长期随访对持续监测人工瓣膜功能和孕产妇健康至关重要。

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引用次数: 0

A case report of jejunal myeloid sarcoma presented with intestinal intussusception in a 19-year-old man: An uncommon presentation of a rare disease 19岁男性空肠髓系肉瘤伴肠套叠一例报告：罕见疾病的罕见表现

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2025-10-16 DOI: 10.1016/j.ijscr.2025.112067

Mojtaba Ahmadinejad , Alireza Shakerpour , Pegah Azarimanesh , Babak Mansourian , Yasmina Ahmadinejad , Javad Zebarjadi Bagherpour

Introduction

Intussusception is a rare condition in adults, with an adult-to-pediatric incidence ratio of approximately 1:20. Unlike pediatric cases, adult intussusception is almost always secondary to an underlying pathological lesion. Myeloid sarcoma is an uncommon extramedullary manifestation of acute myeloid leukemia and represents a rare cause of gastrointestinal involvement.

Case presentation

We report the case of a 19-year-old male who presented to the emergency department with acute abdominal pain and signs of intestinal obstruction. Abdominal computed tomography revealed jejunal intussusception. An exploratory laparotomy was performed, during which a necrotic lesion was identified on the jejunal wall, along with three additional lesions on the intestinal wall. A frozen section biopsy suggested differential diagnoses, including gastrointestinal stromal tumor (GIST) and intestinal lymphoma. The lesion causing the intussusception was resected with clear margins, while the remaining lesions were left in situ based on intraoperative pathology. Postoperative histopathological analysis confirmed the diagnosis of jejunal myeloid sarcoma. The patient was subsequently re-admitted for resection and re-anastomosis of the remaining lesions and was referred to the oncology department.

Clinical discussion

Adult intussusception is often misdiagnosed due to its rarity and nonspecific presentation. In most cases, it is caused by an underlying lesion, which necessitates thorough intraoperative evaluation and appropriate surgical management. Myeloid sarcoma involving the gastrointestinal tract is exceptionally rare and may mimic other neoplastic conditions.

Conclusion

This case highlights the importance of considering rare hematologic malignancies such as myeloid sarcoma in young adults presenting with intussusception.

肠套叠是一种罕见的成人疾病，成人与儿童的发病率比约为1:20。与儿童病例不同，成人肠套叠几乎总是继发于潜在的病理病变。髓系肉瘤是一种罕见的急性髓系白血病的髓外表现，是一种罕见的引起胃肠道病变的原因。我们报告一个19岁的男性谁提出了急诊科急性腹痛和肠梗阻的迹象。腹部电脑断层显示空肠肠套叠。我们进行了剖腹探查，在此期间，在空肠壁上发现了一个坏死性病变，同时在肠壁上发现了另外三个病变。冰冻切片活检提示鉴别诊断，包括胃肠道间质瘤（GIST）和肠淋巴瘤。切除引起肠套叠的病变，边缘清晰，其余病变根据术中病理保留原位。术后组织病理学分析证实为空肠髓系肉瘤。患者随后再次入院切除并重新吻合剩余病变，并转至肿瘤科。临床讨论成人肠套叠由于其罕见和非特异性表现而常被误诊。在大多数情况下，它是由潜在的病变引起的，这需要彻底的术中评估和适当的手术处理。髓系肉瘤累及胃肠道极为罕见，可能与其他肿瘤相似。结论本病例强调了考虑以肠套叠为表现的罕见血液恶性肿瘤如髓系肉瘤的重要性。

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引用次数: 0