Case Reports in Surgery最新文献

Introduction: Bochdalek hernia (BH), a congenital anomaly that typically manifests in infancy, occasionally presents in adults and can lead to serious complications. "Splenic flexure incarceration" within a BH is a rare but clinically significant event, in which the colonic segment near the spleen becomes entrapped, leading to potential acute complications.

Case presentation: A 51-year-old male with no significant medical history presented with acute abdominal pain, nausea, and an absence of bowel movements. Diagnostic imaging revealed a left-sided BH with splenic flexure and incarcerated omentum, causing marked colonic distension. Emergency surgery was performed, successfully releasing the adhesions and restoring colonic integrity. The patient's postoperative course was unremarkable, and he was discharged in good health.

Conclusion: This case highlights the rarity of adult BH with splenic flexure incarceration, and the need for swift surgical intervention to prevent life-threatening sequelae.

Bochdalek hernia (BH) is a rare paediatric condition, but late diagnoses occur in adults. It occurs following incomplete posterolateral development of the diaphragm. Adult BH is asymptomatic in most cases, but it has the potential of being life-threatening. This case report is of a 35-year-old female patient who presented to us with a history of childhood abdominal discomfort leading to frequent hospitalisation. Presently, she came with complaints of increasing abdominal pain, postprandial vomiting, and a 31% weight loss over 3 months before the current admission to our facility. A preoperative diagnosis of a Type IV hiatus hernia with a possible volvulus was made with the assistance of radiology, which turned out to be left BH intraoperatively. Only the herniated stomach was laparoscopically reduced due to technical difficulties and pexied along the defect to seal it. The postoperative period was unremarkable. This case report highlights the need for maintaining a high index of suspicion and surgical preparedness for BH in patients with high-grade hiatus hernia.

Pasteurella spp. are rare but important zoonotic pathogens that can cause prosthetic joint infection (PJI). We present 3 cases of Pasteurella prosthetic joint infections (PJIs) following close animal contact that required treatment with DAIR (debridement, antibiotics, and implant retention) procedures. An extensive literature review was performed which identified 57 described cases of PJI. Transmission commonly occurred following scratches, bites and licks from cats and dogs. Patients often do not recognise the potential severity of these injuries and should be warned following arthroplasty of the risks of infection due to Pasteurella spp. following close contact with these animals, particularly given the increased morbidity and mortality associated with PJI.

Introduction: De Garengeot hernias are a rare type of femoral hernia which contains the appendix inside the hernia sac. Prompt surgical intervention is required when appendicitis develops within the hernia. Diagnosis and management are often challenging due to the uncommon nature of this condition.

Case presentation: We report the case of a 61-year-old female who presented to the clinic with right lower quadrant pain and an erythematous bulge in the right groin. A CT scan confirmed the presence of a femoral hernia with an incarcerated appendicitis. She was managed by the general surgery team and underwent a staged appendectomy followed by femoral hernia repair via an open anterior approach. The patient recovered uneventfully.

Discussion: De Garengeot hernia is a rare clinical entity which is often misdiagnosed preoperatively. The decision to treat in a one- or two-stage fashion, as well as open or laparoscopically, is nuanced and requires consideration of contamination within the femoral space and if mesh is required for hernia repair. CT imaging can aid in diagnosis but has a relatively low sensitivity and specificity. Prompt recognition and surgical management are critical for preventing complications.

Conclusion: De Garengeot hernia is a rare but serious surgical condition requiring prompt intervention for optimal outcomes.

Pulmonary sequestration is a rare congenital malformation of the lower respiratory tract, characterized by nonfunctioning lung tissue without tracheobronchial communication and receiving its blood supply from the systemic circulation. It can present as either intralobar or extralobar sequestration, with intralobar being more common. Surgical resection remains the treatment of choice, although preoperative strategies such as endovascular occlusion can reduce the risk of intraoperative complications. We report the case of a 52-year-old woman with a history of recurrent pulmonary infections who was referred for evaluation of an incidentally discovered cystic lesion in the left lower lobe following a transient episode of amaurosis fugax. Chest CT revealed a 5.3 cm pulmonary sequestration supplied by a large aberrant artery (AA) originating from the descending aorta. A two-stage hybrid procedure was performed, starting with thoracic endovascular aortic repair (TEVAR) to exclude the AA, followed by video-assisted thoracoscopic surgery (VATS) left lower lobectomy. The patient had an uneventful recovery and was discharged postoperatively. TEVAR was employed as a preoperative strategy to minimize the bleeding risks associated with the large AA during minimally invasive lobectomy. A hybrid two-stage approach using TEVAR followed by VATS is a safe and effective method for managing intralobar pulmonary sequestration with large aberrant vessels. Careful preoperative planning and a multidisciplinary approach are essential for optimal outcomes.

Perforated duodenal ulcers are a rare occurrence in patients with a history of Roux-en-Y gastric bypass (RNYGB). This case report is of a patient who had two separate presentations of perforated duodenal ulcer despite a history of RNYGB and who progressed to a high-output duodenal-cutaneous fistula after failing the second Graham patch. This highlights the impact ulcer disease can have even in RNYGB patients.

Introduction and importance: Enterocutaneous fistulas (ECFs) caused by ingested foreign bodies are extremely rare. Accurate fistula localization is essential for guiding management, especially in comorbid patients at high surgical risk.

Case presentation: We report a 76-year-old woman who developed an ECF secondary to a swallowed chicken bone. Initial imaging suggesting a high small-bowel fistula and severe peristomal skin breakdown prompted consideration of surgery. Extended conservative management allowed skin healing, and follow-up imaging revealed a more distal fistula, supporting continuation of nonsurgical management.

Clinical discussion: Management of ECF is challenging due to morbidity from intestinal failure, electrolyte disturbances, sepsis, and skin damage. Optimal care requires multidisciplinary strategies guided by sepsis control, nutritional support, anatomical assessment, and procedure planning (SNAP framework).

Conclusion: This case highlights the importance of individualized management and careful assessment of fistula location. It also illustrates that prolonged conservative management can achieve acceptable outcomes in high-risk patients.

Gallstones and alcohol consumption are the most common causes of acute pancreatitis. Lung carcinoma typically presents with respiratory symptoms, and in some cases, locoregional or distant metastases. However, acute pancreatitis as the initial manifestation of lung carcinoma is rare. Herein, we report the case of a 75 year-old man who presented with acute pancreatitis and was diagnosed with metastatic lung carcinoma upon evaluation.

Acute appendicitis is rare in the neonatal population, and delayed diagnosis is associated with increased morbidity and mortality. Pneumoperitoneum is infrequently identified on plain radiography in cases of neonatal appendicitis, which can result in delays in diagnosis and intervention. In this case, we report a 15-day-old preterm female neonate who presented with irritability and abdominal distention. A plain abdominal radiograph demonstrated significant pneumoperitoneum, and surgical exploration revealed perforated appendicitis.

Appendicitis and small bowel obstruction (SBO) are common causes of acute abdomen encountered in clinical practice. However, appendicitis as a cause of SBO is very rare and often overlooked, commonly resulting in delayed diagnosis and management. Appendico-ileal knotting, a rare but dangerous way appendicitis could lead to mechanical SBO, occurs when an inflamed appendix forms a ring-like structure through which a small bowel loop herniates, resulting in closed-loop obstruction that could be complicated by small bowel strangulation and gangrene if not identified and intervened early. Preoperative diagnosis of appendico-ileal knotting is very challenging, with most cases diagnosed intraoperatively. We present a case of a 35-year-old female who presented with crampy abdominal pain of 2 days duration associated with vomiting, abdominal distension, and constipation. Blood pressure was unrecordable, and abdominal examination was positive for diffuse guarding, rigidity, and rebound tenderness. A plain abdominal X-ray revealed multiple centrally located air-fluid levels, after which she was diagnosed with SBO and taken to the operating room for exploratory laparotomy. With the intraoperative finding of appendico-ileal knotting complicated by distal ileal gangrene, she was managed with appendectomy, ileal resection, and end ileostomy. Appendico-ileal knotting is a very rare condition with a limited number of case reports in the existing literature. This case report aims to contribute to a better understanding of this condition and emphasize the significance of early identification and intervention in reducing the substantial risk of morbidity and mortality associated with the condition if not managed timely.