Case Reports in Surgery最新文献

Anorectal diseases are a major health threat in the field of health sciences. Fistula-in-ano is one of the treatable complex benign lesions of the rectum and anal canal. Complex high anal fistulas can reoccur even after surgical treatment. Establishing a cure for cryptoglandular fistula-in-ano is problematic, as a significant percentage of these diseases persist or recur if the internal opening of the anal fistula is left untreated. Here, we report a case of complex left anterolateral supralevator anal fistula with communication to the prostate gland that forms a prostatic abscess, as it is very rare. After following Ksharasutra (Ayurvedic medicated seton) treatment with regular wound care, significant regression in the condition was observed. A follow-up scan showed no evidence of fistula-in-ano. A 50-year-old businessman presented with complaints of discomfort deep inside the rectum and perineum associated with pain at the base of the scrotum and pus discharge from the perianal region for 1 year. He was diagnosed to have a complex left anterolateral supralevator anal fistula with communication to the prostate substance after a thorough clinical examination and transrectal ultrasonography. After undergoing Ksharasutra treatment for 4 months, pus discharge completely stopped, and sonofistulogram report showed no evidence of fistula-in-ano. Images of the sonofistulogram report were documented before and after the treatment. This article highlights the unique feature of Ksharasutra therapy where the fistula extending to the prostate was treated with no loss of function of the anal sphincter.

Background: Cholecystoenteric fistulae are rare complications of gallstone disease, with a reported incidence of 0.5% to 0.9% of cholecystectomies. Cholecystoduodenal is the most common fistula followed by cholecystocolonic fistulae. Summary: We report a case of pneumobilia resulting from a combined cholecystoduodenal and cholecystocolonic fistulae treated with a laparoscopic subtotal cholecystectomy and open repair of the enteric fistulae. Conclusion: Combined cholecystoduodenal and cholecystocolonic fistulae are an extremely rare complication of gallstone disease, and meticulous preoperative planning and operative dexterity are needed to safely manage these unusual fistulae.

This case study discusses a 47-year-old Caucasian male with a past medical history of dyslipidemia, gastroesophageal reflux disease, previous cervical spine surgery, and anxiety who developed a neck hematoma postrevision of a C5-6 cervical spine fusion. Emergent neck exploration and evacuation of the hematoma were performed, and ventilation was restored. The patient was transferred to the intensive care unit and extubated on postoperative day 5 with a stable wound and no residual bleeding. At the 3-week follow-up appointment, the patient was noted to be doing well, with a chest radiograph showing no effusion or hematoma. This report elucidates the challenges posed by acute clinical symptoms and their correlation with the underlying cause, as well as the subsequent management and outcomes of a neck hematoma complication following cervical spine surgery.

Premature ovarian insufficiency (POI) is associated with decreased ovulation in the precursor stage which leads to ovarian failure in the end stage. Metabolic-bariatric surgery (MBS) can improve women's reproductive status, including the release of sex hormones, ovulation, and fertilization. Here, we report a spontaneous pregnancy following MBS despite potential ovarian insufficiency. A 38-year-old woman with severe obesity underwent three cycles of assisted reproduction that were not successful. Oligomenorrhea ≥ 4 months, laboratory indices, and previous poor ovarian response approved the diagnosis of diminished ovarian reserve and could be considered as the precursor stage of POI. Then a gastric bypass was applied, and a spontaneous pregnancy occurred in the 22^nd month after surgery, with 45.80% reduction in body mass index. MBS in women with obesity and idiopathic ovarian insufficiency may increase the chance of spontaneous ovulation and successful pregnancy.

Background: Unintentionally retained foreign bodies in the breast are a rare phenomenon. Most reported cases are iatrogenically derived from surgeries and procedures. Only a handful of reported cases refer to noniatrogenic causes, including bullets, a sewing needle, and a headscarf pin. However, there are no reports to date that describe a retained foreign body in the breast after a motor vehicle collision or a similar traumatic event or from a decorative steering wheel emblem decal. Case Description: We report the case of a 25-year-old female who was involved in a motor vehicle collision with airbag deployment that led to a left breast retained foreign body, a steering wheel emblem decal. On presentation to the emergency room, she reported left chest pain associated with a puncture wound lateral to the left nipple. Imaging at that time was consistent with a metallic object embedded in the subcutaneous tissue of the left breast. Four months after the accident, the patient continued having daily burning pain in the associated area. As such, surgical excision was recommended, and wire-localized excision of the foreign body was subsequently performed. Grossly, the foreign body appeared as a metallic object with rhinestones, which the patient confirmed was a decorative emblem decal that was on her steering wheel. The postoperative course was uncomplicated, and follow-up examinations revealed resolution of the left breast pain. Conclusions: This case underscores a unique presentation after a common accident-a retained foreign body in the breast after a motor vehicle collision-and its successful surgical intervention leading to a favorable postoperative course. Notably, the National Highway Traffic Safety Administration recently advised drivers against adding decorative emblem decals to their steering wheels for this reason. The case therefore highlights safety precautions that should be taken regarding the addition of this type of accessory.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain and inflammation in over 30 million individuals daily. Gastrointestinal bleeding (GIB) associated with NSAID consumption has been well documented in gastric and duodenal bleeding; however, NSAID-associated GIB distal to the duodenum lacks extensive documentation. This report highlights small bowel occult bleeding related to NSAID use in a patient with a surgical history of robotic total colectomy with ileorectal anastomosis completed 1 year prior. In the case of bright red blood per rectum with associated NSAID use, we recommend NSAID cessation followed by an individualized treatment plan, such as upper/lower endoscopy and/or angioembolization.

Autoimmune neutropenia (AIN) is an extremely rare condition, and there is no effective treatment option for this disorder. AIN can cause major complications in patients with perioperative infection. Herein, we present a 56-year-old female patient who was scheduled for breast cancer surgery. However, she was unexpectedly diagnosed with AIN. Thus, the surgery was postponed, and endocrine therapy was started. After 7 months of treatment, the surgery was performed. Granulocyte colony-stimulating factor was administered before the surgery, but the patient's neutrophil count did not increase. Thus, levofloxacin was administered during the surgery. The patient had fever (38.6°C) 1 day after the surgery. Her surgical wound did not present with redness, and there were no other signs of infection. The fever subsided on the second day after the surgery. Nevertheless, antibiotics were administered for 5 days. The patient was discharged on the sixth day after the surgery.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a group of rare autoimmune disorders associated with the presence of ANCA autoantibodies. We present the first reported case of acute ANCA-associated vasculitis following coronary artery bypass grafting in a 74-year-old male presenting on postoperative day 13 with shortness of breath, orthopnea, and acute kidney injury. Renal biopsy ultimately showed focal necrotizing and crescentic glomerulonephritis, and the patient was successfully managed with corticosteroids and outpatient rituximab. This rare case highlights the importance of having an expanded differential for uncommon causes of cardiovascular disease and unexpected outcomes after coronary artery bypass grafting.

Background: On December 2019, a novel coronavirus disease (COVID-19) spread worldwide and became a pandemic. Multisystem inflammatory syndrome in children (MIS-C) due to cytokine release syndrome following COVID-19 presents with various manifestations. We hypothesize that one of the rare manifestations is acute abdomen. Case Presentation. In this case series, eight cases (five girls and three boys) of gastrointestinal (GI) involvement and acute abdomen were reported to be associated with the cytokine storm due to COVID-19 infection. All patients were of Iranian nationality (Caucasian ethnicity), with a mean age of 8.9 years (range 3.5-14). They all presented with fever and acute abdominal pain. Additionally, maculopapular rash and edema of the extremities were common presentations. Free fluid on abdominal ultrasound or computerized tomography (CT) scan was observed in all patients. All cases tested positive for COVID-19. In six cases, laparotomy or abdominal surgery was performed for a diagnosis of acute abdomen, but appendicitis was confirmed in only one case. None of the cases presented with phlegmon. Elevated serum lipase and amylase levels were noted in two cases. Seven patients received corticosteroid pulse therapy. Clinical symptoms improved after one or two doses, and all patients were discharged after 4 weeks of follow-up with no mortality or morbidity.

Conclusion: Patients experiencing unexplained acute abdominal pain along with fever, skin rash, and peripheral edema, who had a history of COVID-19 infection prior to or during the episode of acute abdomen symptoms, should be considered to have MIS-C. Furthermore, methylprednisolone pulse therapy could be a safe treatment option, reducing hospitalization duration in this patient population.

Introduction: Sump syndrome is a rare complication following bilioenteric anastomosis, most commonly following choledochoduodenostomy. This is only the third case in the literature of sump syndrome of the distal common bile duct (CBD) following end-to-side Roux-en-Y choledochojejunostomy (RYCJ). Case Presentation. A 69-year-old man with a history of end-to-side RYCJ for recurrent primary choledocholithiasis presented 3 years postoperatively with right upper quadrant (RUQ) abdominal pain affecting his quality of life. The work up revealed mild leukocytosis and computed tomography (CT) imaging that showed dilation of the distal CBD remnant. He underwent endoscopic retrograde cholangiopancreatography (ERCP) with the removal of large amounts of debris with initial resolution of his pain, but the pain recurred after several months and after two further ERCPs with only short-term resolution of pain, he eventually underwent an open distal CBD excision and the pain has since resolved.

Conclusions: This case report describes a rare case of sump syndrome following RYCJ that presented with abdominal pain alone. Sump syndrome may have a wide array of presenting symptoms, and the pathophysiology of sump syndrome varies based on bilioenteric reconstruction. Although it has rarely been reported to occur in the distal blind CBD remnant following either RYCJ or hepaticojejunostomy, it is important to consider this in the differential for patients with abdominal pain following any bilioenteric reconstruction.