International Journal of Surgery Case Reports最新文献

Introduction: Endolymphatic sac tumors are rare, indolent tumors with an initially innocuous presentation of audiovestibular dysfunction mimicking benign, less sinister aetiologies. The objective of this study was to describe the clinical and pathologic features of endolymphatic sac tumors, highlighted by one such case presenting to a tertiary Neuro-otology and Skull Base center.

Presentation of case: We report a case of a destructive endolymphatic sac tumor of the middle ear resulting in cranial neuropathies of the facial, vestibulocochlear, and vagus nerves. The acute clinical decline alongside aggressive features of disease seen on skull base imaging prompted urgent surgical exploration for histological diagnosis. Local multidisciplinary collaboration of neuro-otology and skull base surgeons, neuro-radiology, and pathology led to successful diagnosis and initiation of management.

Discussion: Retrospectively, the patient had a 10-year history of hearing loss, vertigo, and tinnitus leading to the erroneous diagnosis of Meniere's syndrome. Endolymphatic sac tumors pose a diagnostic challenge owing to their initial innocuous presentation. Differentiating these tumors from other pathologies both radiologically and histologically also poses a challenging - emphasizing the need for multidisciplinary input and tertiary-level management.

Conclusions: The lateral skull base surgeon must be cognisant of this rare pathology and of the potential ramifications the diagnosis may have due the association of endolymphatic sac tumors with von Hippel-Lindau syndrome.

Introduction and importance: The study is aimed to introduce an arthroscopic repair technique using a double-loop suture assisted by a direct dorsal approach for treatment of TFCC dorsal tear and report the results.

Case presentation: From 2021 to 2023, eight patients underwent arthroscopy and were diagnosed with dorsal tear of TFCC, who were included and retrospectively reviewed. The double-loop suture repair technique through direct dorsal approach (about 0.5 cm proximal to the 6 R portal) was applied.

Clinical discussion: The visual analogue scale (VAS) score, modified Mayo score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, wrist range of motion, and grip strength were measured pre- and postoperatively. At the final follow-up (9-15 months, mean 11.8 months), all the eight patients achieved satisfactory results. The grip strength was increased significantly. The modified Mayo wrist and DASH scores showed significant functional improvement. The mean VAS score decreased from 4.0 to 1.1. After repairing dorsal tear of TFCC using double-loop technique through direct dorsal approach, satisfactory function and pain relief were achieved.

Conclusion: The optimized approach and simple operation make it a safe and effective strategy for repair of TFCC dorsal tear.

Level of evidence: IV; retrospective study.

Introduction: Splenic cysts are uncommon lesions, broadly classified into true (epithelial-lined) and false (pseudocyst) categories. Secondary splenic cysts, often resulting from trauma, are typically presumed in patients with a history of blunt abdominal injury.

Presentation of case: We present a case of a 34-year-old male with a large splenic cyst incidentally discovered more than a decade after remote abdominal trauma. Imaging and history favored a diagnosis of post-traumatic pseudocyst, leading to spleen-preserving cystectomy. Histopathological analysis unexpectedly revealed an epithelial-lined primary splenic cyst.

Clinical discussion: This case emphasizes the limitations of imaging in differentiating cyst types and the importance of histopathology for accurate diagnosis. It also supports spleen-conserving surgical approaches when the cyst morphology permits.

Conclusion: While trauma-based pseudocyst was suspected, histopathology confirmed an epithelial cyst. Spleen-preserving surgery with follow-up is a sound strategy in such cases.

Introduction: Bleeding, an unavoidable yet mostly controllable event in surgery can present with intimidating challenges. The risks are calculably more and foreseeably torrential when confounded with a known bleeding diathesis like Hemophilia. Already a rare finding due to an X-linked recessive inheritance in females, the condition is also exceedingly uncommon in children.

Presentation of case: We hereby present an 8-year-old girl with hemophilia A presenting with acute recurrent appendicitis. She underwent a standard three-port laparoscopic appendectomy as an emergency procedure using 3 mm instruments under suitable anesthesia and perioperative factor VIII replacement. She had an entirely uneventful perioperative period with an optimal outcome.

Discussion: All hemophiliacs, regardless of severity, are at risk of bleeding and present with unique surgical challenges, especially in rare cases of female hemophiliacs presenting with appendicitis, as demonstrated by this case. Moreover, management requires robust laboratory and blood bank support, along with close coordination between the surgeon and anesthesiologist at all times. Laparoscopic techniques can provide a safe and effective outcome even in such cases.

Conclusion: This case demonstrates that with a precisely tailored surgical and anesthetic management strategy, desired result can be achieved even in such high-risk cases.

Introduction: Congenital diaphragmatic hernia (CDH) manifests as a result of incomplete closure of the diaphragm muscles during embryological development. Most cases are diagnosed during the antenatal period or may manifest during the first week of life. In this case, we have reported a child patient with a late-presenting left congenital diaphragmatic hernia with bowel obstruction diagnosed by an X-ray alone.

Presentation of case: An 8-year-old boy presented with severe generalized abdominal pain, associated with vomiting, constipation, and difficulty in breathing. On examination, the child had a scaphoid abdomen with no audible bowel sounds. His chest had no air entry on the left side, audible bowel sounds on the left, mediastinal shift to the right side of the chest, and muffled heart sounds on the left side of the chest. Chest-abdominal X-ray, erect view, revealed multiple bowel loops in the left hemithorax with loss of the left hemithorax dome, cardiac silhouette shifted more to the right side of the chest. Emergency laparotomy was done with good post-operative recovery.

Discussion: Delayed (late-presenting) congenital diaphragmatic hernia (CDH) is an uncommon clinical entity that poses diagnostic and therapeutic challenges because it often presents outside the neonatal period with heterogeneous respiratory or gastrointestinal symptoms and is frequently misdiagnosed.

Conclusion: This report reinforces the need for clinicians - particularly in resource-limited settings - to consider CDH in older children with compatible clinical and radiographic features and demonstrates that timely surgery based on careful chest radiograph interpretation can lead to good outcomes.

Introduction and importance: Gossypiboma, or retained surgical sponge, is a rare iatrogenic complication post-surgery, often mimicking malignancies like ovarian cancer in postmenopausal women. This leads to unnecessary oncologic interventions, patient anxiety, and procedural risks. Incidence ranges from 1:1000 to 1:18 000 procedures, with hysterectomies at higher risk due to human errors in counting. Recognizing imaging features is crucial to prevent misdiagnosis, highlighting the importance of multidisciplinary evaluation and preventive protocols in gynecological surgery.

Case presentation: A 56-year-old asymptomatic postmenopausal woman, 9 years post-hysterectomy for fibroids, underwent routine transabdominal ultrasound revealing a 7.23 × 15.63 × 16.30 cm heterogeneous right adnexal mass initially interpreted as malignant ovarian neoplasm by a junior radiologist. Senior review and CT scan showed whorled structure with sterile gas, suggesting gossypiboma.

Clinical discussion: Gossypibomas can remain latent for years, presenting as fibrotic masses with gas on imaging, mimicking tumors. Diagnostic pitfalls arise from inexperience, as seen here, but pathognomonic signs like spoke wheel patterns aid differentiation. Complications include obstruction or fistula; management involves surgical removal. Prevention requires standardized counting, radiopaque markers, and education to eliminate never events.

Conclusion: This case emphasizes the need for high suspicion of gossypiboma in post-hysterectomy adnexal masses to avoid erroneous cancer diagnoses. Adhering to safety protocols enhances surgical integrity and patient outcomes.

Introduction and importance: One-anastomosis gastric bypass (OAGB) is a common bariatric intervention with recognized safety but rare hematologic complications. Thrombotic thrombocytopenic purpura (TTP) has not been reported following OAGB.

Case presentation: A 20-year-old female with morbid obesity (BMI 49.5 kg/m²) underwent OAGB with no complications initially. On postoperative day 11, she presented with abdominal pain, convulsion, anemia, and severe thrombocytopenia. The patient underwent an exploratory laparoscopy that ruled out intra-abdominal pathology. Peripheral blood smear revealed schistocytes in favor of TTP. Then, the patient was transferred to a tertiary care center. Plasma exchange and corticosteroid therapy were initiated promptly, which led to rapid clinical improvement with an increase in platelet count from 30 × 10³ to 271 × 10³ after seven plasma exchange sessions, and Hb improved from 6.4 to 9.5 g/dL at discharge. She had a stable condition at discharge and appropriate weight loss in her follow-up.

Clinical discussion: TTP is recognized as an emergency medical condition that can mimic surgical postoperative complications. Unlike previous reports of TTP following sleeve gastrectomy or cardiac surgery, this case occurred after OAGB, which is a procedure not previously associated with this complication. In this case, early gastrointestinal symptoms initially suggested surgical causes, but the acute decrease in platelet count and microangiopathic hemolysis were two diagnostic indicators. Plasma exchange therapy remains the cornerstone in treatment and significantly increases survival rates when started early.

Conclusions: Although clinically rare, TTP should be considered in post-OAGB patients presenting with unexplained cytopenia and neurological symptoms. Early diagnosis and prompt initiation of plasma exchange are critical for lifesaving outcomes.

Introduction: Gangliocytic paraganglioma is rare duodenal tumor characterized by distinctive histological features including neuroendocrine, ganglion and Schwann-like cells. It is typically benign, though occasional regional lymph node metastasis have been reported, and most patients present with gastrointestinal bleeding or obstruction. Recurrence after resection is rare.

Case presentation: We present a 46-year-old male presented with a 15-day history of melena, fatigue and dizziness. Initial hemoglobin was 10.7 g/dl, which dropped to 8.2 g/dl during admission. Upper GI endoscopy revealed a large pedunculated lesion in the second part of duodenum. Endoscopic ultrasound (EUS) demonstrated a 3-4 cm submucosal mass without lymphadenopathy and EUS-guided biopsy confirmed gangliocytic paraganglioma. CT scan showed a 2.7 × 3.5 × 2.7 cm exophytic duodenal lesion. The patient subsequently underwent duodenal mass resection. Final histopathology was consistent with gangliocytic paraganglioma. postoperative recovery was uneventful and he remained asymptomatic at 6 months follow-up.

Discussion: Duodenal gangliocytic paraganglioma is a rare neoplasm that may present with variable symptoms, most commonly gastrointestinal bleeding. Radiological imaging plays an important role in localizing the lesion and excluding metastatic disease, though definitive diagnosis relies on histopathology. While endoscopic resection may be feasible for small, localized tumors. surgery is often required for definitive management in cases of significant bleeding or concern for incomplete excision.

Conclusion: Duodenal gangliocytic paraganglioma should be distinguished from other neuroendocrine tumors. The possibility of malignant behavior with nodal or distant spread should be excluded prior to surgery. Careful treatment planning and long-term follow-up are essential.

Introduction and importance: Endometrioid adenocarcinoma of the uterine cervix is rare and difficult to distinguish from endometrial adenocarcinoma. It has been referred to as a diagnostic challenge, particularly due to rare endometrioid subtypes that can mimic endometrial carcinoma and are associated with a poorer prognosis. This report presents a case of rapidly progressing endometrioid adenocarcinoma to emphasize this unusual clinical course.

Case presentation: The 62-year-old patient (G2P2) with an unremarkable medical history presented with asymptomatic endometrial fluid detected on routine ultrasound. Subsequent workup, including fractional curettage and MRI, revealed cervical cancer, which was staged as FIGO IB1. The patient underwent radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection, with final pathology revealing moderately differentiated endocervical adenocarcinoma (ECA) invading the endocervical canal and uterine isthmus, and negative lymph nodes. The patient had an uneventful postoperative recovery and remains disease-free at 6 months of follow-up.

Clinical discussion: This case highlights the diagnostic difficulty of endometrioid ECA, a rare non-HPV-associated subtype often misidentified as endometrial carcinoma. Rapid progression despite negative cytology underscores Pap smear limitations for glandular lesions. Early radical surgery with adjuvant therapy and multidisciplinary evaluation remain essential for optimizing patient outcomes.

Conclusion: The diagnosis of endometrioid ECA is challenging due to its rarity, and determining the tumor's origin remains particularly difficult. Furthermore, the phenomenon of "rapid-onset" cervical carcinoma, often an adenocarcinoma, warrants attention because Pap smears have lower sensitivity for detecting glandular lesions than squamous lesions.

Introduction: Non-puerperal uterine inversion (NPUI) is a rare condition in which the uterus turns inside out caused by a non-puerperal or gynecological condition. Management for NPUI includes surgery, with several available methods. In this case, we present a case of NPUI with a conservative management employing an abdominal-vaginal approach.

Case report: A 40-year-old nulliparous woman came due to hemorrhagic shock caused by vaginal bleeding and protruding mass from the vagina. Transabdominal ultrasound revealed the absence of uterus in the abdomen. She was resuscitated with intravenous fluid and blood transfusions. We decided to perform a surgery with combined abdominal-vaginal approach. Vaginal myomectomy was followed by uterus repositioning using the Kustner technique with extended incision to the uterine corpus. Hysterorrhaphy was performed to preserve the uterus. There was no complication after surgery.

Discussion: NPUI is a rare tumor-related condition that poses diagnostic and surgical challenges. Imaging aids early recognition, while surgery remains as the main treatment. This case highlights successful uterine preservation using a combined vaginal-abdominal approach with the Kustner method.

Conclusion: This is a rare condition with risks of injuries to the pelvic organs during surgery. Gynecologists face difficulties in diagnosing and treating it promptly. As surgery is the main management in this case, selecting the appropriate method is essential. Fertility preservation was achieved in this case with an abdominal-vaginal surgical approach.