Case Reports in Surgery最新文献

Trichobezoars are accumulations of undigested hair. Usually, this disorder follows a psychiatric etiology; however, sometimes a nonpsychiatric etiology, such as pica, can also be suspected. Rapunzel syndrome is a rare type of trichobezoar in which the hair is usually confined to the stomach and small intestine. The authors present a rare case of trichobezoar in a young female without any psychiatric symptoms. Trichobezoar results in nonspecific GI symptoms and this causes delays in its diagnosis. It should always be considered a differential in a young female with nonspecific GI symptoms, especially in those with evidence of iron deficiency anemia.

Background and importance: Meningiomas are one of the most frequent primary central nervous system (CNS) tumors. According to the World Health Organization (WHO) classification of brain tumors, meningiomas are categorized into Grade 1 (benign meningioma; 80%), Grade 2 (atypical meningioma; 4%-15%), and Grade 3 (anaplastic meningiomas; 1%-3%). Grade 2 meningioma has a higher recurrence rate, ranging from 29%-52%. However, the transformation from atypical meningioma into benign meningioma is poorly understood. The present article describes a patient with Grade 2 meningioma that transformed into a benign subtype. Case presentation: A 51-year-old female with a history of seizures, presented with left-sided progressive weakness. Radiological imaging revealed a large extra-axial parasagittal lesion measuring 5 cm × 5 cm × 4.8 cm, suggestive of meningioma. The patient underwent subtotal resection of the lesion. Histologically, the tumor was in favor of Grade 2 meningioma. Radiological follow-up 8 years postoperatively revealed a recurrent meningioma. The patient underwent right-sided craniotomy and resection of the parasagittal meningioma. The histopathological features were suggestive of a Grade 1 meningioma. Conclusion: The transformation from atypical to benign meningiomas is rarely reported and the mechanism remains unclear. The present case provides insights into the natural history of this entity, describes possible etiologies, and lists the surgical management with an emphasis on preoperative radiological imaging and histopathological investigations.

Background: Caecal volvulus in the paediatric population is uncommon, yet at worst this condition is a life-threatening surgical emergency. In children, caecal volvulus can be associated with a variety of predisposing factors such as chronic constipation, intestinal malrotation, or neurological disease. Case Representation: We present a rare case of caecal volvulus, internal hernia, and an intestinal rotational abnormality in a previously healthy 8-year-old boy. The patient presented with a history of abdominal pain and vomiting for 3 days and was admitted to the hospital in a severe septic shock. After the initial stabilisation with fluids and vasopressors, an emergency laparotomy was performed. A necrotic caecum volvulus, a transmesocolic hernia, and an abnormal rotation of the small intestine were diagnosed. The necrotic bowel segment was resected in a right-sided hemicolectomy, after which a resection distal to medial colic artery was cut-off to achieve normal anatomy. The patient was discharged on the 12th postoperative day in good health and has since returned to normal active life without any health issues within the follow-up of 5 months. Conclusions: Caecal volvulus and internal hernia can lead to a life-threatening condition requiring immediate surgical treatment. Rare causes of abdominal pain in children should be kept in mind when severe symptoms are present.

Paraganglioma of the middle mediastinum has a prevalence of 1%-2% of paragangliomas and less than 1% of mediastinal masses. It is generally asymptomatic and can easily be confused with other pathologies. The following is the case of a 50-year-old patient who, as an incidental finding, documented an injury between the aorta and the pulmonary artery, hypervascularized, which was embolized prior to surgery, which facilitated the complete resection of the lesion by sternotomy. With favorable evolution of the patient and discharge on the fourth postoperative day. A thorough review of the literature on the diagnostic and treatment approach to this pathology has been also carried out.

Staghorn calculi pose challenges in urology, often necessitating more invasive procedures such as percutaneous nephrolithotomy (PCNL) to clear a large stone burden with fewer procedures. Here we present a case of a 76-year-old female with chronic kidney disease and a malrotated right pelvic kidney who underwent PCNL for a 3.5 cm staghorn calculus. Postoperatively, she developed a rare complication of ascending colon perforation, requiring emergent surgical intervention including exploratory laparotomy and right hemicolectomy. Colon perforation during PCNL is rare (0.3%-0.8%). Preoperative imaging, namely computed tomography (CT) of the abdomen and pelvis, is crucial to identify anatomical variations and mitigate the risk of injury. Conservative management strategies have demonstrated success in similar cases, emphasizing the importance of prompt recognition and multidisciplinary management. This case contributes to the paucity of literature regarding this rare complication underscoring the necessity for detailed preoperative planning to avoid complications in PCNL, especially in patients with complex renal anatomy. Future research should focus on developing tailored guidelines for PCNL in patients with anatomical abnormalities to enhance procedural safety and optimize outcomes.

Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumors of unknown etiology composed of myofibroblastic cells admixed with inflammatory cells. Presented is a 72-year-old male hospitalized for severe abdominal pain and hematochezia with onset of associated symptoms of fever and sweats a few hours prior to abdominal pain. A computed tomography (CT) demonstrated left colonic thickening interpreted as partial obstruction, gross adhesions, and ischemia. At surgery, marked bowel ischemia from the distal transverse to proximal sigmoid colon was seen with extensive gross adhesions. Histopathology revealed a mesenteric mass chiefly composed of stellate-to-spindled myofibroblastic cells and fibrous adhesions, intermixed with lymphocytes, histiocytes, and plasma cells. The tumor was positive for desmin, smooth muscle actin, and keratin; tumor staging, grade, and postsurgical follow-up were not completed as the patient expired postoperatively. Illustrated is a rare pathologic mimic of ischemic colitis with fibrous adhesions, IMT. Thus, it should not be assumed that fibrous adhesions are always the etiology of obstruction when "adhesions" between sections of bowel are noted radiologically or surgically.

Mastoid obliteration can be performed after canal wall down (CWD) mastoidectomy with various materials. Homologous bone tissue harvested from cadaver donor represents a feasible option with advantages. The purpose of the study is to describe the case of a patient diagnosed with middle ear cholesteatoma treated with mastoidectomy of the CWD and mastoid obliteration with homologous freeze-dried corticocancellous bone particulate in the Cittadella Hospital Ear, Nose, Throat (ENT) unit. The preoperative characteristics of the patients, the procurement and processing of bone allografts, the surgical technique, and postsurgical outcomes are described. No perioperative and postoperative complications were observed, and no rejection or foreign body reactions occurred. The patient then underwent a seriated follow-up. Audiometric tests showed an improvement in hearing levels. The volume of the neoexternal ear canal was 2.01 cm³. The case demonstrated clinical stability, substantial hearing recovery, and no need for specialist cleaning of the reformed external ear canal (EEC). The freeze-dried bone tissue allograft, in the technical way we used, appears to be a viable option in mastoid obliteration because homologous bone is not affected by material shortage, has fast assimilation, and ensures a useful radiological examination scan, at a low cost.

Background: Odontoid fracture (OF) is one of the most common spinal fractures. Type II in D'Alonzo's classification is still the most common and should be considered unstable unless proven otherwise. Thus, surgical stabilization has received significant attention. Although posterior displacement is common in type II OF, complete displacement is extremely rare, and very few reports are available in the literature. Case Presentation: We report the case of a 60-year-old man with acute type II OF with complete posterior displacement and myelopathy. The patient was managed utilizing a posterior-only single approach for reduction and stabilization. Conclusion: Posterior displacement of type II OF has been traditionally managed with close reduction and anterior or posterior stabilization. Closed reduction in cases of complete posterior displacement carries a significant risk of neurologic deterioration. Anterior, combined, and posterior approaches have been taken for this condition. The posterior-only approach in experienced hands has the least mortality and morbidity with at least the same neurologic and fusion outcomes.

Iatrogenic aneurysms of the splenic artery constitute a rare yet potentially severe complication arising from diverse medical or surgical interventions. The clinical complexity and challenging management strategies associated with these aneurysms pose significant difficulties for clinicians. This circumstance is exemplified in our case report, detailing an iatrogenic aneurysm of the splenic artery that emerged secondary to a pancreatic fistula following a median pancreatectomy performed for a Frantz tumor. The intricate clinical presentation of this case underscores the considerable management challenges posed by such iatrogenic complications.

Background: Schwannomas are well-encapsulated, solitary tumors that grow slowly from the nerve sheath. Sellar schwannomas tend to be mistaken for other sellar/parasellar lesions due to similar clinical and radiological findings. The present article describes the clinical presentation, radiological findings, histopathological features, and outcome of a patient with sellar schwannoma. Case Description: A 23-year-old female, known to have hypothyroidism secondary to Hashimoto's thyroiditis, presented with multiple episodes of galactorrhea, weight gain, and irregular menstrual cycle for 8 months. It was associated with decreased visual acuity and episodic headaches. Neurological examination revealed no focal deficits. Brain magnetic resonance imaging (MRI) showed a well-defined lobulated lesion in the sellar region, compressing the right optic nerve and optic chiasm. The patient underwent craniotomy and tumor resection. The histopathological sections were diagnostic of schwannoma. Postoperatively, the patient noted a subjective improvement in her visual acuity. She was discharged in stable condition with regular follow-ups at neurosurgery, endocrine, and ophthalmology clinics. Conclusion: Schwannoma of the sellar region is rare and can be misdiagnosed as pituitary adenomas. Preoperative hormonal profile and meticulous neuroradiological assessment narrow down the differential diagnosis for patients with sellar lesions. The diagnosis of sellar schwannomas is established with histopathology and immunohistochemistry results.