Case Reports in Surgery最新文献

Cauda equina syndrome (CES) results from compression of the cauda equina (CE) nerve roots and presents with a spectrum of neurological deficits. We report four cases of CES with symptom durations ranging from 3 days to 1 month at presentation. The clinical features included urinary incontinence, reduced perianal sensation, lower limb weakness, and erectile dysfunction in select cases. Despite delays in surgical intervention for some patients, all demonstrated significant postoperative improvement in bladder function and lower limb strength. Bladder sensation began to recover within 5-20 days postoperatively, with complete bladder function restoration achieved between 10 and 120 days. While early surgical decompression remains the standard for optimal outcomes, these cases suggest that meaningful recovery is still possible following delayed intervention. Prompt diagnosis and timely surgery, even in late-presenting cases, may improve functional outcomes. Our series reports early postoperative timelines for recovery and aligns observations with key domains from CES core outcome set in low- and middle-income countries.

McKittrick-Wheelock is a rare syndrome characterized by a severe, difficult to correct electrolyte imbalance, chronic mucus diarrhea, and a large rectal polyp. In this case report, we describe an elderly patient diagnosed with a large nonmalignant rectal polyp during a routine colonoscopy 10 years prior to admission. For years, the patient has suffered from diarrhea, causing episodic life-threatening hypokalemia and hyponatremia with several unsuccessful attempts at endoscopic polyp removal. Due to symptomatic cholelithiasis, the patient was transferred to the surgical ward and diagnosed with McKittrick-Wheelock syndrome. The patient had undergone cholecystectomy and, after a period of preoperative preparation, underwent an abdominoperineal resection of the rectum. Histopathologic evaluation revealed a low-grade (G1) rectal carcinoma. This case report highlights the importance of a careful assessment of patients with electrolyte level disturbances, with some, albeit very rarely, requiring surgical intervention.

Background: Male breast cancer (MBC) is rare, accounting for only 1.8% of all breast cancer cases diagnosed globally. However, there is a rising trend in its incidence over the past decades. Spontaneous regression (SR) of a tumor, on the other hand, is a rare but well-documented phenomenon.

Case presentation: We reported a case of MBC that showed SR in the surgical specimen after the histopathologic diagnosis of invasive breast cancer in the core needle biopsy sample. A 58-year-old gentleman presented with a palpable left retroareolar mass, nipple retraction and intermittent pain for 2 months. Imaging and histopathological examination (HPE) confirmed an estrogen- and progesterone-receptor-positive, HER-2 negative invasive carcinoma, which was treated with left mastectomy with axillary clearance (MAC). Intraoperatively, no breast mass was palpable, and SR of the tumor was reported for the surgical sample.

Conclusion: This case not only emphasizes the rarity of MBC but also draws attention to the exceptional phenomenon of SR in invasive carcinoma. Recognition of such rare events underscores the importance of cautious decision-making, multidisciplinary management, and further research into the biological and immunological mechanisms underlying tumor regression.

Upper extremity pseudoaneurysms are uncommon, and involvement of collateral branches of the brachial artery is particularly rare. A 78-year-old woman without antecedent trauma presented with a new pulsatile mass and progressive dysfunction of the proximal arm. Duplex ultrasonography provided sufficient diagnostic and planning information, demonstrating a pseudoaneurysm arising from a collateral branch of the brachial artery measuring 38 mm × 29 mm × 46 mm, with an estimated neck diameter of 3 mm and neck length of 5 mm, and a thin peripheral mural thrombus. Given lesion size and compressive features, open repair was performed under general anesthesia: sac excision and arterial reconstruction with a reversed basilic vein interposition graft using end-to-end anastomoses. The postoperative course was uneventful, with discharge on postoperative Day 1; at 7-day follow-up, duplex ultrasonography confirmed patency of the reconstructed segment without stenosis, residual sac, arteriovenous fistula, or signs of distal ischemia. This case supports open venous autologous reconstruction as an effective option for large and compressive arterial pseudoaneurysms of brachial collateral branches.

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.