Case Reports in Surgery最新文献

We describe a rare case of a mechanical small bowel obstruction secondary to multiple enteroliths expelled from underlying jejunal diverticular disease. A 59-year-old male, without any past surgical history presented to a regional hospital in Queensland with symptoms consistent with an acute small bowel obstruction. A CT scan performed on arrival confirmed the diagnosis of a small bowel obstruction with a transition point at the level of mid small bowel however the aetiology was not radiologically apparent. He proceeded to an exploratory laparotomy which revealed at least three intraluminal enteroliths, one of which was impacted within the mid jejunum resulting in the bowel obstruction. These enteroliths were all milked distally and successfully retrieved via an enterotomy in a healthy segment of distal ileum. He was also noted intraoperatively to have extensive proximal jejunal diverticular disease as the likely source of his dislodged enteroliths. Retrospectively, his CT scan could be correlated to his intraoperative findings, bringing to light this rare phenomenon which has been documented only in a handful of published cases within surgical and gastroenterology literature.

Introduction: Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon form of non-Hodgkin's T-cell lymphoma associated with textured breast implants and tissue expanders.

Case presentation: A 46-year-old female presented with a 1-week history of a firm lump in the upper inner quadrant of her right breast. She had a history of augmentation mammoplasty with textured implants 8 years prior. Ultrasound guided biopsy of the 15 mm × 18 mm mass confirmed a diagnosis of BIA-ALCL on histopathology. Pre-operative staging with PET CT showed a peri-implant nodule with avid nodules within and deep to the pectoralis muscle with no evidence of distant metastases. Bilateral en bloc removal of the breast implants, capsulectomy (including palpably involved pectoralis major and minor muscles) and right axillary dissection were performed. Final histopathology confirmed BIA-ALCL, pT4N0, with clear margins. Post-operative PET-CT demonstrated complete excision of local disease, however, a new FDG-avid right internal mammary node was identified, which increased in size and avidity on follow up imaging. Mediastinoscopy with core biopsy were performed and histopathological features were consistent with metastatic cells (BIA-ALCL). Patient subsequently completed six cycles of adjuvant chemotherapy with evidence of interval response on imaging. To date, patient remains in complete clinical and radiological remission and the expected duration of follow up is 5 years.

Conclusions: BIA-ALCL poses a significant challenge due to increasing use of implants for reconstructive and cosmetic procedures. Patients most commonly present with peri-implant fluid collections but palpable masses, capsular contracture and lymphadenopathy are also commonly seen. Diagnosis involves ultrasound and histopathological analysis of fluid or tissue with CD30 immunohistochemistry and staging with PET-CT. Patient education and a multidisciplinary team approach allow for timely diagnosis and complete surgical excision, which are key for a good prognosis. Clinical and radiological surveillance detect early recurrence and assess need for adjuvant therapy.

Introduction: Hepatic cystic mucinous neoplasm is a low-prevalence tumor with malignant potential. Due to its infrequent presentation, it is often misdiagnosed and inadequately treated. The purpose of the present work is to report a case, review the corresponding literature, determine the most optimal surgical treatment option, and contrast it with what has been performed.

Clinical case: A 53-year-old female patient with upper hemiabdomen pain and elevated serum liver enzyme levels. Computed tomography revealed a multilocular cystic liver tumor measuring 52 mm × 63 mm between segments 4 and 5. The patient underwent a first surgery, laparoscopic unroofing. The anatomopathological result was mucinous cystic neoplasm (MCN-L) without malignancy. With the result, a second surgery was scheduled to complete the resection of the remaining cyst, and an open left hepatectomy was performed.

Discussion: MCN-L of the liver is an infrequent presentation and occurs in <5% of cystic liver tumors. Because this tumor has malignant potential, complete surgical resection is the best treatment option.

Conclusion: We present a case of MCN-L of the liver with two-stage complete resection because this tumor, although benign, has a high potential for malignancy and recurrence.

Superior mesenteric artery (SMA) syndrome is an extremely rare condition that can result from a multitude of causes that devoid the mesenteric fat pad or structurally narrow the space resulting in duodenal obstruction. It is predominantly seen in females. If not treated, it can result in life-threatening complications. Herein, we present four patients with SMA syndrome who presented to our outpatient department at Adera Medical and Surgical Center, Addis Ababa, Ethiopia.

Introduction: Retained surgical instruments (RSIs) are rare but serious surgical complications. This report presents a unique case of a retained surgical blade identified 12 years post-hysterectomy, highlighting diagnostic challenges and the need for vigilance.

Case presentation: A 60-year-old female presented with chronic abdominal pain for 4 years, initially misdiagnosed as urinary tract infection (UTI) and gastritis. Investigations, including X-ray and computed tomography scan (CT scan), revealed a retained surgical blade. Elective laparotomy was performed, and the rusted blade, encapsulated by the omentum, was removed. Postoperative recovery was uneventful.

Discussion: The delayed diagnosis underscores vulnerabilities in surgical safety protocols. Nonspecific symptoms of RSIs often lead to delayed detection. While manual counting is the standard, human error can occur. This case emphasizes the need for advanced technologies and standardized protocols. Underreporting of RSIs obscures true rates, necessitating improved data transparency and systemic learning.

Conclusion: This case highlights the importance of multidisciplinary collaboration, technological integration, and institutional accountability to prevent RSIs. Enhanced postoperative surveillance and heightened clinical suspicion are crucial. This will improve patient safety and uphold healthcare credibility. This case underscores the need for long-term postoperative vigilance, even in the absence of immediate symptoms.

Postoperative adhesions present a complex surgical challenge, often leading to complications, such as small bowel obstruction (SBO). Among these, appendicular band syndrome, although rare, is a serious condition that underscores the importance of meticulous management of the appendix stump during surgery to prevent life-threatening outcomes. We report a case of a 67-year-old female who presented to the emergency department with post-prandial epigastric pain and vomiting. Notably, she did not open her bowels for the last 2 days. The patient had a medical history of hypertension and gastroesophageal reflux disease, and previous surgeries, including laparoscopic appendectomy and ovarian cystectomy. Computed tomography revealed a high-grade, incomplete SBO. Diagnostic laparoscopy revealed thick band adhesions arising from a residual appendiceal stump from previous appendectomy site, which had caused a clockwise torsion of jejunal loops; division of the band and completion appendicectomy resolved the obstruction. These findings highlights the complex interplay between surgical technique and stump length in preventing adhesion formation. The formation of adhesions is primarily initiate from disturbances to peritoneal mesothelial surfaces, triggering inflammatory and coagulation pathways. Our discussion delves into the optimal management of the appendix stump, highlighting current literature that suggests a stump length of approximately 5 mm as optimal for minimising the risk of both stump appendicitis and appendicular band adhesions. While traditional inversion of the stump may limit exposed mucosa, it is not universally recommended because an inverted stump can later mimic a caecal mass or create diagnostic uncertainty. When a laparoscopic endoloop technique is selected, achieving a critical view of the appendix with complete visualisation of the caeco-appendiceal junction before ligation, allows precise placement of the loop flush with the base, thereby keeping the residual stump short and reducing the risk of stump appendicitis. Identifying high-risk patients, with prior abdominal surgery or severe intra-operative inflammation, and tailoring stump management accordingly remain crucial to preventing complications, such as appendicular band syndrome.

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.