Case Reports in Surgery最新文献

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.

A male in early adolescence presented with 1 week of chest pain, respiratory symptoms and diarrhoea. Thoracic computed tomography (CT) revealed suspicious findings of necrotising mediastinitis without signs of a descending infection. The patient underwent bilateral thoracotomy and laparotomy with several revisions. After 58 days in the hospital, the patient was discharged home, fully recovered, with no sequelae. This case highlights the importance of a multidisciplinary approach when managing severe and rare conditions, emphasising the need for early diagnosis and prompt, appropriate surgical treatment.

Introduction: Chilaiditi's sign consists of the interposition of a segment of the intestine between the right diaphragm and the liver; when this anomaly causes gastrointestinal symptoms, it is referred to as Chilaiditi's syndrome. If conservative treatment fails, surgical intervention is often necessary, especially in severe or complicated cases. Case Presentation: An 82-year-old woman with a 2-year history of right-sided abdominal pain, constipation, malaise, and weight loss was diagnosed with Chilaiditi's syndrome following an extensive workout to exclude other pathologies. Following the failure of medical therapy, she underwent elective robotic surgery for hepatic flexure mobilization and right colopexy. The procedure was performed using the Versius robotic system (Cambridge Medical Robotics, CMR), resulting in successful repositioning of the colon and resolution of symptoms. Discussion: Chilaiditi's syndrome is often underdiagnosed and can be effectively treated with surgical intervention in cases unresponsive to medical therapy. The Versius robotic system offers a highly effective, minimally invasive solution, reducing surgical trauma, and promoting faster recovery. This case highlights the benefits of robotic-assisted surgery in managing complex gastrointestinal conditions like Chilaiditi's syndrome. Conclusion: Robotic surgery, particularly with the Versius robotic system, offers significant technical advantages in such complex cases due to its precision and minimally invasive nature, with improved clinical outcomes, and enhanced recovery times for patients requiring surgical intervention.

Omental infarction was first described in 1896 mimics other causes of acute abdomen. Improved imaging modalities such as ultrasound and CT scans, have enhanced preoperative diagnosis with conservative management emerging as a treatment option. We report the case of a 51-year-old man presenting with epigastric pain migrating to the right iliac fossa, fever, nausea and anorexia. Examination revealed a stable patient with a right lumbar mass (5 cm × 6 cm) and rebound tenderness. CT imaging identified fat stranding near the ascending colon and hepatic flexure (6 cm ×10 cm ×10 cm) with peritoneal thickening. He underwent exploratory laparotomy, omentectomy and peritoneal washout, which revealed an infarcted omentum (8 cm × 8 cm) and 200 ml of haemoserous fluid. The patient recovered well postoperatively. A systematic search of the literature identified 237 articles reporting 479 cases of omental infarction, with clinical data extracted for analysis. Male predominance was observed (2:1) and 326 patients (68.1%) underwent surgical intervention. Conservative management was successful in 121 patients (25.3%), while 32 (6.7%) required surgery following failed conservative treatment. Among those managed surgically, the most common preoperative diagnosis was appendicitis. CT imaging was performed in 245 cases (51.1%), of which 103 (42.0%) within this group were successfully managed conservatively, while 26 (10.6%) required surgical intervention after conservative failure. Omental torsion was diagnosed preoperatively in 220 patients (45.9%); in this subset, 21 (9.5%) underwent surgery after failed conservative management and only 5 (2.3%) were successfully treated conservatively. While omental infarction can often be managed conservatively, surgery remains a key treatment for intractable pain or omental torsion, where conservative management failure rates are high.

We present our experience with a patient with acute-on-chronic asymptomatic pneumoperitoneum with spontaneously resolving idiopathic pneumatosis intestinalis that was solely managed on close observation alone. This case is unique in that it details the approach to nonoperative management of massive free air under the diaphragm identified incidentally on routine preventative health screening and longitudinal follow-up over an 8-month period. In the absence of known and underlying systemic disease, efficient and coordinated clinical work-up and evaluation for comorbid diagnoses associated with pneumoperitoneum can serve to guide management and avoid unnecessary surgery for stable and asymptomatic patients.

Introduction: Angiogenic leiomyosarcoma (LMS), a soft tissue sarcoma, primarily occurs in the inferior vena cava (IVC) in over 50% of cases, with renal vein LMSs being exceedingly rare. We present a case of primary LMS of the left renal vein. Case Report: A 73-year-old woman with a history of hypertension and prior left colon adenocarcinoma presented with intermittent left flank pain. Imaging revealed a large left latero-aortic mass. Exploratory laparotomy confirmed a multinodular tumor around the left renal hilum, necessitating en bloc resection with left nephrectomy. Pathological examination identified it as a grade 2 LMS. The patient recovered well postoperatively with no complications. Discussion: LMSs, especially of vascular origin, are rare and aggressive malignancies. Despite their insidious presentation, they predominantly manifest in women, typically adults, and often on the left side. Diagnosis is challenging due to nonspecific symptoms and imaging findings. Surgical resection remains the cornerstone of treatment, with complete resection offering better outcomes. Prognosis is poor, particularly with larger tumors, partial resection, and high-grade lesions. Adjuvant therapy's efficacy is uncertain. Conclusion: LMS of the renal vein is a rare entity with challenging diagnosis and management. Radical surgical resection remains the mainstay, but prognosis is guarded, especially in high-risk cases. Further research is needed to optimize treatment strategies for this rare malignancy.

Background: Intestinal intussusception is a common condition in children, and the cause is often idiopathic. In contrast, adult intussusception is rather rare and almost always secondary due to an underlying condition such as a tumor, inflammatory disease, or a diverticulum. Hence, the treatment almost always is surgical resection of the lesion. Methods: We retrospectively analyzed a case of asymptomatic intussusception in a male adult using patient data retrieved from the hospital patient database. This includes findings from both physical and radiological and endoscopical examinations. The patient was contacted 4 weeks and 6 months postsurgery for a clinical follow-up. Aim: Until this day, there is no guideline regarding the underlying pathology. Hence, this case report wants to contribute to a field where there is only insufficient patient data. Results and Discussion: We presented a case of colocolic intussusception in an adult caused by a large intramural lipoma. After a full gastrointestinal diagnostic protocol and interdisciplinary case discussion, we decided to offer surgical resection, from which the patient recovered quickly. The benign nature of the tumor and the complete lack of symptoms despite significant tumor size make this case particularly interesting. We emphasize the need for a larger study group to create robust data that aid in creating care guidelines.