Case Reports in Surgery最新文献

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.

Sacrococcygeal teratomas are rare in adults, despite being common in infants. Adult presentations are often asymptomatic and may go undetected until complications arise. We report a case of a 20-year-old female with a long-standing sacral swelling. Imaging revealed a large, well-circumscribed mixed solid-cystic mass in the presacral region causing displacement of pelvic structures. Surgical excision of the tumor was done along with the surrounding rectal wall. Early surgical intervention is essential to prevent malignant transformation and optimize outcomes.

Peptic ulcer disease (PUD) results from erosion and ulceration of the upper digestive tract mucosa. Clinical presentations can vary from asymptomatic to severe complications such as perforation, strictures, or bleeding. Perforation can release enteric contents and gas into the abdomen, leading to intra-abdominal sepsis, requiring surgical intervention for source control and repair. We present a case of a 69-year-old male who developed both Fournier's gangrene and a right-sided pneumothorax secondary to a nontraumatic perforated duodenal ulcer. The patient underwent an emergent thoracostomy, laparotomy with Graham omentoplasty, and extensive debridement with successful outcome. While rare complications like pneumothorax and necrotizing soft tissue infections have been documented, their simultaneous occurrence from a nontraumatic ulcer perforation is unprecedented in literature. Previous reports suggest enteric contents can traverse retroperitoneal fascial planes and peritoneal defects to reach distant anatomical sites as a possible mechanism for these complications. This case highlights the potential for atypical presentations of PUD and the importance of comprehensive evaluation, early recognition, and prompt surgical intervention.

This is a case report of an alternate laparoscopic reconstruction possibility in a patient that required a cephalic duodenopancreatectomy (DPC) who previously underwent a Roux-en-Y gastric bypass (RYGB). The question of what type of reconstruction is to be performed in such patients is thoroughly debated in this article.

Intestinal malrotation is often considered a disease of the newborn. It involves the failure of the 270° counterclockwise rotation of the midgut during embryonic development. Patients typically present with symptoms such as bilious vomiting and can further be diagnosed through imaging. The complications of intestinal malrotation include midgut volvulus which can cause ischemia of the intestine. In order to prevent this feared complication and treat malrotation, the four-step Ladd's procedure was developed. Proficiency of the procedure is more common among pediatric surgeons due to the higher incidence rate of malrotation; however, it can occur at any age. Adult presentations are reported to account for only 0.2%-0.5% of all cases of intestinal malrotation. Due to that, adult general surgeons are less likely to encounter the pathology and need to perform a Ladd's procedure. However, with the consequences being so dire, the ability to perform Ladd's procedure remains important in all general surgeons. In this report, we present two cases of intestinal malrotation in adults managed with Ladd's procedure and emphasize the importance with familiarity of both the pathology and procedure.

Seminal vesicle cyst (SVC) is a rare condition that can arise from congenital or acquired causes. In this report, we describe the case of a 33-year-old male who was incidentally discovered to have SVC and seminal vesicle stones following complaints of abdominal pain. He presented to the emergency department with these symptoms, which prompted further investigation and diagnosis. Computerized tomography (CT) scan revealed diverticulitis and a fluid attenuation lesion within the right aspect of the prostate gland. He was referred to urology, and further evaluation showed a right SVC of 1.8 × 1.5 × 1.5 cm on magnetic resonance imaging (MRI). The patient underwent endoscopic drainage of the SVC via transurethral seminal vesiculoscopy (TRU-SVS) and holmium laser incision. Three stones ranging from 2 to 4 mm were identified and removed with N-gage basket from the seminal vesicle resulting in successful removal of the stones and restoration of the ejaculatory duct's patency. Follow-up visits showed resolution of pain and an improvement in semen volume. This case report highlights the importance of considering SVC as a differential diagnosis in male patients presenting with such symptoms. TRU-SVS is a feasible and effective treatment option for SVC and associated seminal vesicle stones.

Benign liver tumors are infrequently observed in the pediatric age group, with an incidence reported at 0.7 per million population annually. Among these tumors, mesenchymal hamartoma constitutes 18%-29%. Imaging studies commonly reveal a well-marginated, solitary mass, often measuring up to 30 cm. The mass, primarily located in the right liver lobe (75% of cases), may exhibit a pedunculated structure. We present a case of a 1-year-and-9-month-old boy diagnosed with hepatic mesenchymal hamartoma. A contrast-enhanced computed tomography of the abdomen and magnetic resonance imaging (MRI) were performed and demonstrated a large multiloculated septated liver lesion measuring approximately 13.6 × 17.7 cm, demonstrating multiple partially thickened internal septations. The procedure was done for the patient in the form of an extended right hepatectomy with segment 4A and cholecystectomy.

Fibrosarcoma is a rare malignant neoplasm consisting of fibroblasts with a large variety of collagen production. They usually involve deep soft tissues in extremities and trunk. However, fibrosarcoma can be seen in fields that received previous irradiation. Here, we report a case of parastomal fibrosarcoma after laparoscope-assisted extra-levator abdominal perineal resection (ELAPE) and colostomy. Prior to surgery, the patient underwent neoadjuvant chemoradiotherapy. The patient received extensive stomal lumpectomy and stoma reconstruction. The patient is free of local or distal recurrence for 1 year and died 4 years after diagnosis.

Primary neuroendocrine tumors (NETs) predominantly affect postmenopausal women. This case study focused on a 54-year-old woman who presented with a painless right breast lump. While the lump exhibited estrogen and progesterone receptor (PR) positivity, it lacked human epidermal growth factor receptor 2 expression. Further evaluation revealed positivity for the neuroendocrine markers chromogranin A (CGA) and synaptophysin (SYN). It also revealed a 3% positive Ki-67 proliferation index. Treatment for neuroendocrine breast cancer (NEBC) mirrors that of standard invasive breast cancer: breast conservation or mastectomy combined with sentinel lymph node biopsy or axillary dissection. The patient underwent a right mastectomy with sentinel lymph node biopsy, followed by hormonal therapy based on her tumor's immunohistochemical profile. Due to the low incidence and limited research on primary NETs, their exact origin remains shrouded in mystery. Accurate diagnosis, specific treatment options, and long-term prognosis remain significant challenges in managing this rare form of breast cancer.

Well-differentiated liposarcomas are common retroperitoneal lesions, but exceedingly rare when primary to the small bowel mesentery, with only a handful of cases reported in the literature. Presented is a patient with a primary mesenteric well-differentiated inflammatory liposarcoma with mucosal extension at high risk for misdiagnosis. A broad differential diagnosis with careful histopathologic observation, ancillary immunohistochemical studies, and fluorescent in situ hybridization for MDM2 amplification are key to make a correct diagnosis. This is especially true if such a lesion was first noted in the lamina propria on histopathology from an endoscopic mucosal biopsy.