CRSLS : MIS case reports from SLS最新文献

Introduction: Extrauterine leiomyomas, including ovarian leiomyomas, are difficult to diagnose given their rarity, especially in the absence of synchronous uterine leiomyomas or a history of a myomectomy. Primary ovarian leiomyomas have historically been managed with oophorectomy, frequently via laparotomy, due to challenges related to preoperative diagnosis and risk stratification of a solid pelvic mass.

Case description: This is the case of a 27-year-old nulliparous female who presented with 1 episode of abnormal uterine bleeding and mild intermittent left sided pain in the setting of attempting conception. Ultrasound revealed a solid adnexal mass and tumor markers were within normal limits. Laparoscopic mass removal, preserving the ovary, was performed and final pathology resulted as leiomyoma. The patient was able to spontaneous conceive shortly after surgery.

Discussion: This case report highlights the feasibility of laparoscopic ovarian conserving management of primary ovarian leiomyoma following the appropriate clinical workup and patient counseling, with consideration for the patient's age and desire for future fertility.

Introduction: Small bowel obstruction is a common surgical problem. Volvulus as a cause of obstruction is rare, and duodenal volvulus has only been described in case reports.

Case description: A 60-year-old male presented with abdominal pain and emesis in the setting of significant weight loss. He was identified to have a spontaneous duodenal volvulus with massive gastric outlet obstruction, due to superior mesenteric artery (SMA) syndrome. He underwent laparoscopy with successful reduction of the volvulus and creation of a duodenojejunostomy.

Discussion: Here we review all published cases of duodenal volvulus and present the first case of duodenal volvulus in the setting of SMA syndrome, treated with a minimally invasive approach.

Background: The urachus is a vestigial remnant of the allantois which naturally degenerates after birth. Failure of closure of the urachus can result in urachal malformations, with the most common being a urachal cyst. Diagnosing a urachal cyst is challenging due to its diverse presentations, often leading to misdiagnosis. Although they are often asymptomatic, urachal cysts can be significant because they can lead to complications.

Case report: We report a late preterm male infant born at 36 weeks + 5 days, in whom an antenatal anomaly scan revealed a unilocular intra-abdominal cyst adjacent to the bladder. Postnatal ultrasound kidney, ureter, and bladder (KUB) at 3 days of age demonstrated a cystic structure anterior and superior to the bladder, accompanied by mild bilateral hydronephrosis. A voiding cystourethrogram (VCUG) at 2 weeks revealed a cystic mass connected to the bladder by a fistulous tract, raising differential diagnoses of urachal cyst, bladder diverticulum, or incomplete bladder duplication. At 2 months, diagnostic cystoscopy and laparoscopy were performed. Cystoscopy showed a small opening at the bladder dome, while laparoscopy identified a 5 × 5-cm cyst extending from the bladder dome to the umbilicus. The cyst was excised laparoscopically, and bladder repair was completed. Histopathology revealed benign urothelium with mild chronic inflammation and a muscular wall, suggestive of a urachal diverticulum. Postoperative recovery was uneventful, and follow-up imaging demonstrated normal bladder morphology and renal function.

Conclusions: Our case supports the efficacy of diagnostic and therapeutic laparoscopy in accurately diagnosing urachal anomalies, aiding in treatment decisions, and preventing future complications.

Introduction: The surgical management of malignant breast tumors has undergone significant evolution. There is an increasing need to adopt less traumatic and aggressive procedures, favoring minimally invasive techniques that provide oncologically safe outcomes, superior cosmetic results, and fewer complications-particularly through endoscopic and robotic approaches.

Case presentation: We present the case of a 48-year-old female with no relevant medical history, in whom multiple suspicious lesions were detected in the left breast during routine screening. Histopathological evaluation confirmed an infiltrating lobular carcinoma, luminal B subtype. Following a favorable response to neoadjuvant chemotherapy, a skin- and nipple-sparing endoscopic mastectomy was performed, assisted by a robotic arm that holds the camera, with immediate reconstruction.

Discussion: Skin- and nipple-sparing surgery aims to provide optimal local disease control, improve cosmetic outcomes, and reduce complication rates. Minimally invasive techniques, whether endoscopic or robotic, can be combined safely and effectively to achieve these goals, as demonstrated in this case, which resulted in excellent cosmetic outcomes and no postoperative complications.

The incidence of obesity nationwide has led to an increase in both medicinal and surgical interventions, with recent studies indicating a drop in obesity prevalence for the first time in over a decade. Laparoscopic Roux-en-Y gastric bypass remains one of the most commonly performed bariatric procedures in the United States, accounting for about 22% of all bariatric surgeries in 2022. While considered a safe procedure, gastric bypass results in an anatomic configuration that poses a unique challenge from both a surveillance and interventional standpoint. The gastric remnant, biliopancreatic (BP) limb, and extrahepatic biliary tree are not readily accessible vis-à-vis esophagogastroduodenoscopy and thus require a novel approach for evaluation. Symptomatic small bowel diverticula are by themselves a rare entity. When present in the gastric bypass patient, this combination makes for a uniquely challenging case for both diagnosis and management. Surgical exploration with or without intraoperative endoscopy may be the only modality for both localization and management of symptomatic small bowel diverticula in this patient population.

Background: Diaphragmatic rupture is a rare but potentially life-threatening injury that can result from blunt or penetrating trauma. Timely diagnosis is critical to prevent serious complications, yet clinical and radiological assessments are often inconclusive.

Case presentation: We report the case of a 39-year-old male patient who sustained blunt thoracoabdominal trauma in a motor vehicle accident. The patient presented with respiratory distress and generalized abdominal tenderness. Imaging revealed a left diaphragmatic defect with herniation of abdominal organs into the thoracic cavity.

Surgical technique: The patient underwent diagnostic laparoscopy, which confirmed an 8 × 5 cm defect in the left diaphragmatic dome with herniation of the stomach and omentum. The herniated organs were reduced, and the defect was repaired tension-free using intracorporeal 0-silk sutures. A 28-Fr intercostal drainage tube and a 12-Fr abdominal drain were placed.

Outcome: The postoperative course was uneventful. A chest x-ray on postoperative day one confirmed normal diaphragm position and re-expansion of the lung. The patient recovered without complications.

Conclusion: Laparoscopy provides a minimally invasive and effective diagnostic and therapeutic option for diaphragmatic rupture following blunt trauma. In appropriately selected cases, it offers favorable outcomes with reduced morbidity.

Introduction: Splenic cysts are rare lesions that are classified as either true (primary) or false (secondary) cysts based on their epithelial lining. The pathogenesis of primary splenic cysts is not well understood, and several hypotheses have been proposed, including the Mesothelial invagination theory, which postulates that during development, the mesothelial lining invades along with the capsule. As the lining has a pluripotent nature, it has the propensity to undergo metaplasia and secretion of fluid, leading to the formation of cysts.

Case presentation: A 12-year-old female patient presented with a visible upper abdominal, painless cystic lesion, underwent blood tests and radiological diagnostic tools, such as abdominal ultrasound and computed tomography (CT) scan, but no definite diagnosis could be reached. Ultrasound-guided aspiration of the cyst was done, followed by explorative laparoscopy with total excision of the cyst (which was found to originate from the spleen), accompanied by partial splenectomy. The cyst was diagnosed as a benign primary mesothelial cyst of the spleen by histopathology. The patient experienced an uneventful postoperative period and showed no recurrence during follow-up.

Conclusion: A significant challenge for surgeons in terms of diagnosis, surgical planning, and managing intraoperative surprises is the difficulty in detecting the origin and nature of a large abdominal cyst, despite the availability of highly sophisticated diagnostic tools. Minimally invasive partial splenectomy in the pediatric age group is a feasible surgical intervention.

Pneumoperitoneum in infancy raises concern for visceral perforation and resultant urgent surgical exploration. However, benign pneumoperitoneum-defined as free intraperitoneal air without gastrointestinal perforation-can occur rarely, especially in infants with chronic ventilatory dependence. We present an unusual case of an 8-month-old infant with severe bronchopulmonary dysplasia (BPD), tracheostomy, and gastrostomy-tube dependence, with radiographic evidence of pneumatosis intestinalis and free intraperitoneal air. Diagnostic laparoscopy was performed which identified air within the mesentery of the small and large intestine, without evidence of true pneumatosis, perforation, inflammation, or ischemia. The patient recovered from their surgery uneventfully without any complications. This case highlights the importance of recognizing benign pneumoperitoneum, particularly in medically complex ventilator-dependent pediatric patients, and emphasizes the role of diagnostic laparoscopy as a valuable tool to confirm bowel integrity, preventing unnecessary laparotomy.

Introduction: Intussusception occurs when one segment of bowel invaginates into an adjacent segment of bowel from a lead point. Literature suggests a nonpathological lead point attributed to adult intussusception: marijuana. This report describes a unique presentation of intussusception in a patient with a history of previous surgical intervention and marijuana use.

Case presentation: We report a 33-year-old male with a history of surgically treated intussusception and 12 years of marijuana use, who presented to the emergency department (ED) twice with nausea, vomiting, and abdominal pain. After imaging revealed intussusception, the patient underwent multiport-robot-assisted small bowel resection. The patient had no complications and was discharged after 6 days.

Conclusion: Intussusception can be deadly if not caught early. The use of marijuana can mislead clinicians due to similar appearing presentations. This case highlights the importance of a comprehensive patient history for abdominal pain. Additionally, it suggests placing intussusception higher in the differential for marijuana users.

We present a rare morphological variant of a colonic polyp observed during a routine screening colonoscopy. A 62-year-old male with known chronic obstructive pulmonary disease (COPD) and benign prostatic hyperplasia (BPH) was found to have a bridge-shaped polyp in the sigmoid colon. The polyp was successfully resected via snare polypectomy following submucosal adrenaline injection. Histopathological analysis revealed the lesion to be a hyperplastic polyp. To our knowledge, bridge- or horseshoe-shaped hyperplastic polyps have not been previously reported in the literature.