Case Reports in Surgery最新文献

Schistosomiasis is a parasitic disease caused by blood flukes commonly found in sub-Saharan Africa and select other areas in Asia and the Americas. The disease can manifest in a wide range of acute and chronic conditions, rarely presenting as acute appendicitis. Herein we report a case of a 36-year-old female patient from a nonendemic area (New York City) with a history of travel presenting with acute appendicitis secondary to instestinal schistosomiasis.

Chylous ascites from small bowel obstructions is a very rare finding with only a handful of case reports previously published. This case report of a patient with chylous ascites related to an obstruction from Petersen's hernia supports the trend from existing reports. Prior studies have linked chylous ascites to closed-loop obstructions, such as small bowel volvulus or internal hernia, even when the bowel is viable and does not require resection.

Stump appendicitis is a rare but serious complication following an appendectomy, resulting from incomplete removal of the appendix. It often mimics acute appendicitis with nonspecific symptoms, such as abdominal pain, nausea, vomiting, and fever, making diagnosis challenging. Here, we report the case of a 17-year-old male who presented with diffuse abdominal pain, fever, and nausea just 11 days after undergoing an open appendectomy. Physical examination revealed tenderness at the surgical site, and imaging showed inflammatory changes in the right lower quadrant. Exploratory surgery confirmed stump appendicitis due to retained appendiceal tissue, which was resected. The patient recovered uneventfully.

Introduction: Primary hepatic ectopic pregnancy is rare; it has been reported to have an incidence of 1:15,000 per uterine pregnancy approximately. This study aims to determine the clinical presentation and treatment of hepatic ectopic pregnancy. Presentation of Case: We present the case of a patient with no history of pregnancy who presented with abdominal pain refractory to treatment. With a human chorionic gonadotropin hormone (β-hCG) measure of 55,710 mIU/mL, an abdominal ultrasound that revealed the presence of a rounded image of 50 mm × 50 mm at the level of the right hepatic lobe and the complication of hypovolemic shock. Under the diagnosis of an abdominal ectopic pregnancy, the patient underwent surgery. Discussion: Initially, an exploratory laparotomy was performed, which revealed the presence of bleeding, clots, and a gestational sac; subsequently, a wedge resection was done, and a Pringle maneuver and hepatic packing were performed, obtaining favorable results in the patient's case. Conclusion: The diagnosis of primary hepatic ectopic pregnancy is made through β-hCG measurement and serial abdominal ultrasonography. Treatment can be pharmacological (methotrexate) or surgical, applying techniques such as the Pringle maneuver.

We report the rare case of postoperative perianal abscess after emergency transanal hemorrhoidal dearterialization (THD) with mucopexy for Grade III hemorrhoidal disease (HD). A 68-year-old male presented to our hospital with rectal bleeding due to HD Grade III. He underwent THD with mucopexy with an uneventful postoperative recovery. The patient was evaluated on the 15^th postoperative day due to perianal pain without any abnormal laboratory and imaging findings. One month postoperatively he presented with perianal edema and pus discharge. During the rectal examination, a perianal abscess with a concomitant fistula was identified and was confirmed with an MRI scan. He was submitted to abscess drainage and seton placement. This report aims to raise awareness among colorectal surgeons about the risk for this specific complication during the postoperative period. Further studies, are needed so that the etiopathology of this condition is identified and the risk factors can be controlled and avoided.

Introduction: Breast myofibroblastoma (MFB) is a relatively rare benign tumor that mimics the clinical presentation of malignant tumors of the breast. It has various morphologic variants that can be accurately diagnosed based on histopathology and immunohistochemistry staining. We report a case of MFB in a menopausal woman for pertinent clinical consideration and management. Case Presentation: We report a case of a 57-year-old Tanzanian woman, who presented with a huge right breast mass for 1 year. Initial radiological findings were inconclusive, however, the tissue specimen for histology and immunohistochemical (IHC) confirmed the diagnosis. A simple mastectomy was thereafter performed as a curative therapy. Conclusion: This case presentation underscores the importance of considering MFB as a potential differential for breast tumors especially in menopausal women. Tissue biopsy for histopathology and IHC staining form the cornerstone for accurate diagnosis and appropriate management.

Fistula formation is a connection between anatomic locations that is intrinsically abnormal. A variety of causative etiologies and involved structures exist for these anomalous developments. Fistulas between vasculature and the enteric system are rare. When present, anatomical proximity is the dominant factor in determining which structures are involved. Aortoenteric fistulas involving the esophagus, duodenum, and small bowel are well-known with the stomach also being involved in rare instances. Fistulas involving the inferior vena cava (IVC) and enteric system have also been seen with the stomach, small bowel, and intrathoracic colon following an interposition each represented in reported cases. We present a case of an 82-year-old female with multiple medical comorbidities including opioid dependence, chronic constipation, recurrent lower extremity deep venous thrombosis, recurrent upper gastrointestinal (GI) bleeding, and IVC filter dependence who developed a unique problem. Her presenting complaints were nonspecific, but ultimately a diagnosis of fistula formation between the IVC and sigmoid colon was made. The colocaval fistula described here is the first intraperitoneal case to be reported in the body of literature.

In this paper, we discuss the case of a late presentation, locally advanced rectal cancer that has perforated into the greater sciatic notch, presenting with symptoms of lower limb pain and recurrent falls. In this case, we discuss the complexities of diagnosing and managing atypical presentations of colorectal cancer.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique aimed at temporarily interrupting or limiting blood flow through the aorta, which may be used as a bridge until definitive bleeding control by endovascular procedures or surgery. Despite the main current indication for its use is traumatic massive noncompressible torso hemorrhage, its application in end-stage nontraumatic abdominal and pelvic hemorrhage is progressively increasing. Case Presentation: A 42 year-old male patient was brought to our hospital Emergency Department with acute onset of abdominal pain, hypotension, paleness, and diaphoresis. A computed tomography (CT) was performed evidencing a voluminous retroperitoneal hematoma caused by the rupture of an unknown splenic aneurysm. Emergency open splenectomy with resection of the splenic aneurysm and evacuation of the retroperitoneal hematoma was performed, with the assistance of the REBOA technique. The endovascular balloon was positioned in the aorta, proximally to the celiac axis (Zone 1), through a percutaneous femoral access by the interventional radiologist. Intermittent aortic occlusion enabled proximal bleeding control, adequate myocardial and cerebral perfusion, and allowed surgeons to safely and successfully perform splenectomy by resecting the splenic artery at the origin. Conclusion: REBOA provides a rapid and minimally invasive hemodynamic control in severe hemorrhagic settings and its application in the initial management of nontraumatic abdominal hemorrhage should be strongly advised. Further studies with large sample size focusing on nontrauma patients are needed.

Ureteropelvic junction obstruction (UPJO) is observed in approximately 30% of patients with ectopic kidneys. Due to the narrow pelvic space and risk of injuring aberrant structures, an ectopic pelvic kidney with UPJO presents a unique treatment challenge. Most experiences in treating UPJO in pelvic ectopic kidneys using robotic surgical systems are based on the pediatric population. Only a few cases of successful robotic-assisted surgery in adult patients with this condition have been described. This case reports illustrates that the indications for robotic-assisted surgery for UPJO may safely be expanded to include complex adult cases with pelvic ectopic kidney.